Contact Us
Office Hours:
Mon-Fri:9:00am-4:00pm
Sat, Sun:Closed
Phone: 877-LGGASCO
877-544-2726
Local:812-537-1921
Fax:812-537-3731

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
Name
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
Email Address
Occupation
Employer
Employer Address
,
Length of Employment
Are you currently a student? Yes    No
If so, name of school and year

Please make a copy of your driver's license and drop it by the office, we can make a copy for you while visiting our office.


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.


The deposit can be credited to your account after 12 months of consecutive on time payments. Please call the office after 12 months to request this.

We may collect a current deposit if your meter has been disconnected for non-payment along with a reconnection fee.

In the event any unpaid amount is referred for collections, I agree to pay all costs associated with collecting my account including, but not limited to, collection agency fees, court costs and reasonable attorney fees.


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.