Prefer a Paper Form?
I hearby assume responsibility for service and agreet to pay a security deposit upon request. Failure to submit Tax ID Number will result in a security deposit request. This agreement will continue in force until canceled by oral or written request. By signing this application, I agree that I have received and understand the information in the Rights and Responsibilities Pamphlet.
I accept the terms of this agreement
This application for service is subject to review and acceptance by Sycamore Gas Company. Please Note: If this application is not complete in full and signed, it will not be accepted by the Company. The Company must receive this application at least (3) business days before the effective date. If this application is NOT APPROVED, service will be continued in the current account name, unless the responsible party advises us to disconnect service. This application for new service may be subject to a request for security deposit.