Partner Application

Please complete the form below with your company information.

Company Name*
Name*
First Last
Title*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
By providing my telephone number and checking this box, I agree that AEP Energy and entities calling on its behalf may make calls to the telephone number provided regarding AEP Energy services and special promotions, including calls made using an automatic telephone dialing system. I understand that I am not required to agree to receive such calls as a condition of receiving electric or natural gas supply, or participating in any of AEP Energy's programs.*
- I agree
Please provide your Electric Broker's License Number(s)
OH Broker's License Number
MD Broker's License Number
NJ Broker's License Number
IL Broker's License Number
DC Broker's License Number
PA Broker's License Number
DE Broker's License Number
Other

Please provide your Electric Broker's License Number(s)