Skip to main content
Moving
Save
Outages
Pay
Sign In
Search
Menu
Moving
Save
Outages
Pay
Sign In
Close
My Account
Account Dashboard
Billing & Payments
Usage History
Moving
Notifications
Enter Meter Reading
Bill Comparison
Assistance Programs
Rates
Outages
Report Outage/Check Status
Outage Map
Outage Summary
Emergencies
Text Message Alerts
Streetlight Out
Safety & Preparation
Prevention & Repair
Outage Map Guide
My Energy
Save Energy & Money
My Usage History
My Energy Options
Switch to Natural Gas
Solar & Distributed Energy
Electric Vehicles
Safety
Our Energy Future
Meters
Kids Corner
Customer Service
FAQs
Contact Us
Rights & Responsibilities
About Us
FAQs
News
Projects
Community Involvement
Protecting the Environment
Facts at a Glance
Executive Team
Board of Directors
Our History
COVID-19
Emergencies
Business Customers
Municipalities
Contractors
Forms
Server Error...
Home
>
Forms
>
Natural Gas Service Agreement
Natural Gas Service Agreement
Please fill out completely and sign to ensure prompt service.
Downloadable PDF version
Customer Information
Name
Customer Account Number
Email
Phone
Address for New Service
Township
Select
ACCORD, 12404
ACRA, 12405
ALCOVE, 12007
AMENIA, 12501
ANCRAM, 12502
ANCRAMDALE, 12503
ANNANDLE-ON-HUDSON, 12504
ARDONIA, 12505
ASHOKAN, 12481
ATHENS, 12015
BALDWIN PLACE, 10505
BANGALL, 12506
BARRYTOWN, 12507
BEACON, 12508
BEARSVILLE, 12409
BERNE, 12023
BIG INDIAN, 12410
BILLINGS, 12510
BLOOMING GROVE, 10914
BLOOMINGTON, 12411
BOICEVILLE, 12412
BREWSTER, 10509
CAIRO, 12413
CAMPBELL HALL, 10916
CANAJOHARIE, 13317
CARMEL, 10512
CASTLE PT, 12511
CATSKILL, 12414
CEMENTON, 12414
CENTRAL VALLEY, 10917
CHELSEA, 12512
CHICHESTER, 12416
CLARYVILLE, 12725
CLIMAX, 12042
CLINTON CORNERS, 12514
CLINTONDALE, 12515
COEYMANS, 12045
COEYMANS HOLLOW, 12046
COLD SPRING, 10516
CONNELLY, 12417
COPAKE, 12516
CORNWALL, 12518
CORNWALL-HUDSON, 12520
CORNWALLVILLE, 12418
COTTEKILL, 12419
COXSACKIE, 12051
CRAGSMOOR, 12420
DORMANSVILLE, 12055
DOVER PLAINS, 12522
DURHAM, 12422
EAST DURHAM, 12423
EAST KINGSTON, 12401
EAST WINDHAM, 12425
EARLTON, 12058
EAST JEWETT, 12424
EDDYVILLE, 12401
EDDYVILLE, 12426
ELIZAVILLE, 12523
ELKA PARK, 12427
ELLENVILLE, 12428
ENDICOTT, 13761
ESOPUS, 12429
FISHKILL, 12524
FREEHOLD, 12431
GARDINER, 12525
GARRISON, 10524
GLASCO, 12432
GLENFORD, 12433
GLENHAM, 12527
GOSHEN, 10924
GRAHAMSVILLE, 12740
GREENFIELD PARK, 12435
GREENVILLE, 12083
HAINES FALLS, 12436
HANNACROIX, 12087
HARRIMAN, 10926
HENSONVILLE, 12439
HIGH FALLS, 12440
HIGHLAND, 12528
HIGHLAND FALLS, 10928
HIGHLAND MILLS, 10930
HOLMES, 12531
HOPE FARM, 12532
HOPEWELL JCT, 12533
HUGHSONVILLE, 12537
HUNTER, 12442
HURLEY, 12443
HYDE PARK, 12538
JEWETT, 12444
KERHONKSON, 12446
KINGSTON, 12401
KRUMVILLE, 12461
LAGRANGEVILLE, 12540
LANESVILLE, 12450
LEEDS, 12451
LEXINGTON, 12452
LIBERTY, 12754
LAKE HILL, 12448
LAKE KATRINE, 12449
MAHOPAC, 10541
MAHOPAC FALLS, 10542
MALDEN ON HUDSON, 12453
MARLBORO, 12542
MAYBROOK, 12543
MEDUSA, 12120
MIDDLEBURG, 12122
MIDDLETOWN, 10940
MIDDLETOWN, 10941
MILAN, 12571
MILLBROOK, 12545
MILLERTON, 12546
MILTON, 12547
MODENA, 12548
MONROE, 10950
MONTGOMERY, 12549
MOUNTAINDALE, 12763
MOUNTAINVILLE, 10953
MOUNT MARION, 12456
MOUNT TREMPER, 12457
NAPANOCH, 12458
NEWBURGH POST OFFICE, 12551
NELSONVILLE, 10516
NEVERSINK, 12765
NEW BALTIMORE, 12124
NEW HAMBURG, 12590
NEW PALTZ, 12561
NEW WINDSOR, 12553
NEWBURGH, 12550
NORTON HILL, 12083
NORTON HILL, 12135
OAK HILL, 12460
OLIVEBRIDGE, 12461
OLIVEREA, 12410
PALENVILLE, 12463
PEARL RIVER, 10965
PEEKSKILL, 10566
PINE BUSH, 12566
PINE PLAINS, 12567
PLATTEKILL, 12568
PLEASANT VALLEY, 12569
PORT EWEN, 12466
POTTER HOLLOW, 12467
POUGHKEEPSIE, 12601
POUGHKEEPSIE, 12602
POUGHKEEPSIE, 12603
POUGHKEEPSIE, 12604
POUGHQUAG, 12570
PRATTSVILLE, 12468
PRESTON HOLLOW, 12469
PURLING, 12470
PUTNAM VALLEY, 10579
RAVENA, 12143
RED HOOK, 12571
RENSSELAERVILLE, 12147
RHINEBECK, 12572
RHINECLIFF, 12574
RIFTON, 12471
ROCK TAVERN, 12575
ROSENDALE, 12472
ROUND TOP, 12473
RUBY, 12475
SOUTH CAIRO, 12482
SOUTH DURHAM, 12405
SOUTH WESTERLO, 12083
SALISBURY MILLS, 12577
SALT POINT, 12578
SAMSONVILLE, 12461
SAUGERTIES, 12477
SCOTIA, 12302
SELKIRK, 12158
SHADY, 12409
SHANDAKEN, 12480
SHOKAN, 12481
SLEIGHTSBURGH, 12401
SMITH'S LANDING, 12414
SPRING GLEN, 12483
SPRING VALLEY, 10977
SAINT REMY, 12401
STAATSBURG, 12580
STANFORDVILLE, 12581
STONE RIDGE, 12484
STORMVILLE, 12582
SUGARLOAF, 10981
SUNDOWN, 12782
SURPRISE, 12176
SYRACUSE, 13202
TANNERSVILLE, 12485
TILLSON, 12486
TIVOLI, 12583
ULSTER PARK, 12487
VAILS GATE, 12584
VERBANK, 12585
WEST CAMP, 12490
WEST COPAKE, 12593
WEST COXSACKIE, 12192
WEST HURLEY, 12491
WEST KILL, 12492
WEST PARK, 12493
WEST SHOKAN, 12494
WALDEN, 12586
WALLKILL, 12589
WAPPINGERS FALLS, 12590
WARWICK, 10990
WASHINGTONVILLE, 10992
WASSAIC, 12592
WAWARSING, 12489
WEST POINT, 10996
WESTERLO, 12193
WILLOW, 12495
WINGDALE, 12594
WOODBOURNE, 12788
WOODSTOCK, 12498
Legal Description Lot
Legal Description Block
Is this address a Country Road or State Highway
Yes
No
Nearest Cross Street
Plumber Information
Company Name
Contact Name
Phone
Fax
Mobile
Address
City
State
NY
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
PR
VI
Zip
Is Required
Continue
Close
×