Sign up for CHAMP

Please complete the form below to enroll in CHAMP.
Note: Fields with asterisks must be entered to submit form.

Customer Information
* Name:
PECI Account #:
* Email:
* Daytime Phone:
* Home Phone:
 
Service Address
* Address:
* City:
State:
* Zip Code:
 
Billing Address
Copy from Service fields.

* Billing Address:
* Billing City:
* Billing State:
* Billing Zip:
 
*  Select an Appliance Package:View Package Details
Basic Appliance Package - $10.95 per month
    Includes: Range, Refrigerator, Washer, Dryer, Water Heater
HVAC/Cooling Package only - $14.95 per month
    Compressors are not covered
Deluxe Package (Basic + HVAC) - $21.90 per month
Total CHAMP charge: $
 

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Terms and Conditions
* I agree to the above terms