Contact Us
Office Hours:
Sat, Sun:Closed
Phone: 877-LGGASCO

Prefer a Paper Form?

Click here to download the form as a .pdf, then fax it to us at 812-537-3731.

Residential Service Request

Need service? Fill out the form below and someone will contact you as soon as possible.
Property Information
Please place service in my name effective: View Calendar
To establish my account, Sycamore Gas Company will take a meter reading on the effective date listed above.

Property Type: Purchase    Renting

Contact Information
Spouse Name
Service Address
Mailing Address
if different than service address
Previous Address
if at current address less than 1 year
Work Phone
Home Phone
Cell Phone
Employer Address
Are you currently a student? Yes    No
If so, name of school and year

I hearby assume responsibility for service and agree to pay a security deposit upon 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.

Landlord Information
Landlord Name
Landlord Phone
Landlord Address
Do you want the service turned off if your tenant's application is not approved? Yes    No
If yes, is a tenant currently on the property? Yes    No
Special Note: Please be aware, during the period between October 15 through April 15, if natural gas is your heating source, and it is requested to be turned off, there could be a possibility of frozen pipes unless precautions are taken.