Reliant Cancellation Fee Bill Credit Submission Form

Please fill out the following form to apply to receive a cancellation fee bill credit up to $150.

If approved, your bill credit will apply to your Reliant account in the next 1-2 billing cycles.

First and Last Name

Email Address

Service Address

Contact Phone Number

Reliant Account Number

Cancellation Fee Charged ($)

Upload a copy of your final bill with the cancellation fee from your previous provider:

Upload final bill

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Reliant Cancellation Fee Bill Credit Submission Form

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