FLEX Customer Registration Form

Business Name*
Region*
Key Contact*

First NameLast Name
Role*
For mobile phones, put your provider prefix in the Area Code field (e.g.021) followed by the rest of your phone number in the Phone Number field.
Contact Number*

Prefix (e.g. 021)Phone Number
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Type of Business*
What sort of power supply do you have?*
Are you a Farmlands Shareholder?

Yes
Farmlands Shareholder Number
To make sure we provide you with the best possible solution that meets your needs and goals, please select the following options which are most important to you:
I'm most interested in

Lower Energy BillsResiliencyRevenue generationCertainty of ServiceEnergy IndependenceUnderstand Your Energy UseReturn on Investment (ROI)
Customer Interested in
Nearly done! Just to make sure we are in the right ballpark, please add any additional information you think would help us design the right solution for you.
Additional Info
Source
Should be Empty: