For Natural Gas:
Please take a minute to fill out this form, to help us get a preliminary idea of your business needs. This information will be kept confidential.

* = Required Field

*Business name:

*Contact person:

*Description of business:

*Address 1:

Address 2:

*City:

*State: *Zip Code:

Utility:

*Business phone number of contact person:

*Business fax:
(type "NONE" if you do not have a fax)

*E-mail address of contact:

*Rate class:

*Natural Gas MMbtu usage:
MMbtu Monthly Annual

Monthly usage:

January	MMbtu
February	MMbtu
March	MMbtu
April	MMbtu
May	MMbtu
June	MMbtu
July	MMbtu
August	MMbtu
September	MMbtu
October	MMbtu
November	MMbtu
December	MMbtu

*Desired contract term:

*What month do you want service to begin?

Current supplier:

Natural Gas MMbtu demand (if applicable):
MMbtu

How would you like to be contacted?
Business phone number above. Best time to call
E-mail
Business Fax