SIGN UP FOR GAS SERVICE
Step 1 of 3
REQUIRED FIELDS MARKED WITH
*
WHAT KIND OF SERVICE?
I am switching from another marketer
I need new gas service
TYPE OF SERVICE*
Choose Service
Single Family
Apt/Duplex
Condo/TownHouse
PERSONAL INFORMATION
YOUR NAME*
Last
First
Middle
YOUR SPOUSE'S NAME
Last
First
Middle
BUSINESS NAME
EMAIL ADDRESS*
RE-ENTER EMAIL ADDRESS*
SOCIAL SECURITY #
YOUR SSN #*
-
-
YOUR SPOUSE SSN #
-
-
FEDERAL ID#
Please provide your SSN in order to complete this form. If you do not wish to provide this information electronically, call 770.267.2505 or toll free 866.936.2427 to obtain natural gas service from Walton EMC Natural Gas.
SERVICE ADDRESS
STREET ADDRESS*
CITY*
STATE*
GA
Zip Code*
COUNTY*
PHONE NUMBER*
(
)
-
DESIRED CONNECT DATE
Month
1
2
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5
6
7
8
9
10
11
12
/
Day
1
2
3
4
5
6
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/
Year
2012
2013
2014
New turn-ons only; this date is not guaranteed.
