Transferring Service Form
Address to be Billed (IF DIFFERENT):
Full Name (First, MI, Last):
CHECK ONE OF THE FOLLOWING:
Date Moving In:
Please list an Emergency Contact:
To Schedule your final reading at your current location you must fill out the Terminating Service Form.
Before Submitting you must review "Terms and Conditions" Then type your Initials in the the box to show that you have read the terms and conditons.
(REQUIRED)by initialing this box you are stating that you have read and agree to the "Terms and Conditions" set forth by Piedmont Gas Co.
IF RENTING WE REQUIRE A SECURITY DEPOSIT - WE WILL CONTACT YOU BY PHONE OR MAIL TO LET YO KNOW THE AMOUNT OF THE DEPOSIT.
ALL NEW CUSTOMERS ARE REQUIRED TO FILL OUT APPLICATION - APPLICATION FOR GAS SERVICE IS LOCATED ON OUR APPLICATIONS PAGE UNDER TRANSFERRING SERVICE FORM, BY SUBMITTING APPLICATION YOU AGREE TO BE RESPONSIBLE FOR THE PAYMENT OF ALL NATURAL GAS USAGE AT THE SPECIFIED SERVICE ADDRESS.
Use Box Below for any additional information.