In order to receive an accurate quote, please fill in all required fields. Required fields are marked with an asterick.


Contact Address

Company: *
Contact Name: *
Street Address: *
City: *
 State: *
 Zip: *
Telephone: *
 Fax:
 E-mail:

Service Address

Same as Above


Street Address:
City:
 State:
 Zip:

Local Utility *
 (Only one is required)
Columbia Gas of Ohio
Dominion East Ohio

Current Gas Supplier Information
Supplier Name:
 Expiration Date: (MM/DD/YYYY)
 Current Rate:

Quote Information
Start Date: * (MM/DD/YYYY)
Term: *

Please list the last 12 months of usage, starting with the most current complete month.
       Date *

Usage *
(Please select how it is measured)

MCF CCF DTH


(up to millionth value)

1st
(current month)
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th


   




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