Residential Application - DeKalb-Cherokee Counties Gas District

Save time by filling out the form below so it will be waiting at the office when you come in to establish service, or download the form, print and fill out. Bring it with you to our main office in Fort Payne or Centre.

Have you ever had service with DC Gas before?YesNo
Marital Status: MarriedSingleWidowDivorced
Applicant's Full Name
Mailing Address
City
State
Zip

Service Address
City
State
Zip
Home Telephone #
Cell Phone
Email

Two forms of identification are required. Please see the list of acceptable documents.

Social Security #
Driver's License #
State

Employer
Employer Address
Employer's Telephone #

Spouse's Name
Spouse's Cell Phone #
Spouse's Employer
Spouse's Employer Address
Spouse's Employer's Telephone #

Relative
Relative Telephone #
Relative Address

I rent this property from
I own this property
By inputting your name below, you certify that all statements made by you on this application are true and complete to the best of your knowledge.

Name