Commercial Application

Have you ever had service with DC Gas before?YesNo

Two forms of identification are required.

Full Name
DBA, if applicable
Type of Service
Select Entity TypeLLCSole ProprietorCorporation
Social Security # / Tax ID #
Driver's License #
State Issued
Service Address
City
State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip

Mailing Address
City
State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip
Cell / Business Phone #
Other Phone
Email
Would you like to sign up for paperless billing?YesNo
Employer
Employer Phone #

If Individual / Sole Proprietor

Marital StatusSingleMarriedWidowed
Spouse Name
Spouse Phone
Spouse Social Security #
Spouse Driver's License #
State Issued

Spouse's Employer
Spouse's Employer's Phone #

Contact Person, Other than Applicant

Name
Phone #

By executing this form, the applicant intentionally represents that he/she has full authority to contract for service at the address provided, and in the event he/she does not have full authority to contract for the same he/she will be liable to DC Gas for payment of all costs, fees, and expenses incurred by DC Gas for all work commencing after the application for service.

Name