new gas service application

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Residential Services

Use the form below to apply for natural gas service with Columbia Gas of Pennsylvania or Columbia Gas of Maryland. Please allow at least two weeks prior to your requested connection date. If you need service established sooner, call our Customer Contact Center at
1-888-460-4332.

You may be required to pay a security deposit. If gas is currently off at the location, access will be required. You should have someone available at that address during the day of your service request.

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First Name:		Middle Initial:
Last Name:
Date of Birth:	month/day/year
Social Security Number:		I do not wish to submit my SSN online. Please send me the necessary paperwork and affidavit so I may initiate service.*
Driver's License No: (include state of issuance)
Service Address:
City:
State:
Zip:
Mailing address if different from service address:
Home Telephone:
Employer Name:
Business Telephone:
Fax:
E-mail Address:
I need gas service for:	a purchased property a rental property
If tenant, please provide the name, address and telephone number of the property owner:

Date You Need Service:	month/day/year

Name, address and phone number of contact person outside your household: (friend, family member, etc.)

Additional Comments: (include your current mailing address if you are requesting an affidavit be sent to you)

*We cannot process your application until we receive either a valid Social Security Number for each new account or a written affidavit proving your identity. Once you return the signed affidavit, you must call us at 1-888-460-4332 to establish service.

Note: We can provide better service with more advance notice.

If you previously had service with Columbia Gas, please list your address and account information in the Additional Comments field above. Thank You!