Name * First Name Last Name Company * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Business Description Tell us a bit about your business, facilities, and operations. Gas Consumption/Information Current Natural Gas Provider Account Number Annual Consumption (Specify Dth or Mcf) Currently Under Contract? Yes No Expected Start of Service MM DD YYYY Preferred Pricing NYMEX settlement plus Basis Fixed Managed Price Unknown Preferred Term 6 Month 12 Month 18 Month 24 Month Unknown Citygate Delivery Point UGI NFG PNG DEO Unknown Thank you!
