Customer Application

Customer Application

APPLICATION FOR GAS TRANSPORTATION SERVICE (PLEASE PRINT)

CONTACT PEOPLE (PLEASE PROVIDE 2):

Name:

Title:

Phone:

Fax:

E-mail:

Name:

Title:

Phone:

Fax:

E-mail:

COMPANY INFORMATION:

Legal Business Name:

Nature of Business:

Gas Service Address:

Current Interruptible Rate:

Mailing Address:

City:

State:

Zip:

Billing Address:

City:

State:

Zip:

LOAD & DEMAND INFORMATION: 1 Dth = .974 MCF (average)

Maximum Dth/Day (Dekatherms per Day)

Maximum Dth/Yr (Dekatherms per Year)

Minimum CFH (Cubic feet per hour)

Maximum CFH (Cubic feet per hour)

TECHNICAL INFORMATION

Meter Number:

Meter Phone Number:

Alternate Fuel:

Storage Capacity Alternate Fuel:

Gas Burning Equipment:

Load 1.

Load 2.

Load 3.

Load 4.

Load 5.

DISCLOSURE AUTHORIZATION: please choose a disclosure statement:

	PGW is NOT AUTHORIZED to release any information on my company to suppliers.
	PGW is authorized to release ONLY name/address information on my company to suppliers.

Please sign and date:

Fax to (866) 372-8950

or mail to

Marketing - Major Accounts
Philadelphia Gas Works, 800-3
800 West Montgomery Avenue
Philadelphia, PA 19122