Gas Service Application

Is this for a Single family residence or a Multi-family residence?
Single FamilyMulti-Family
If you checked "Multi-Family," please refer to this document.

Date of your desired service:

12-digit WMGLD Account Number:

Name:

Email

Address:

Floor or Apt.:

Billing Address (if different from above)

Home Phone:

Cell Phone:

Work Phone:

Owner of the property:

Owner Phone Number:

What will you be using gas for (check all that apply):
HeatFireplaceAppliancesAll of the AboveOther

Explain "Other":

HAVE YOU COMPLETED AN ENERGY AUDIT IN THE PAST 3 YEARS?
YesNo
If "Yes," please provide the date:

Is there already gas on the street?:
yesnoNot Sure
IF YES, IS THERE ALREADY A GAS LINE TO YOUR HOUSE?
YesNo
Please confirm that you understand that WMGLD is only responsible for the service pipe to the inlet of the meter set. The customer is responsible for piping from the outlet side of the meter set.
I understand

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