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Dear customer,

In order to make more choices available to you now and in the future, Columbia may periodically provide customer lists that would include your name, address, rate classification and usage information to qualified third parties.

You have the right to restrict in whole, or in part, the release of your private customer information. You can choose to restrict the release of your historical billing information (annual usage) only, or you can choose not to have any information about your Columbia Gas account included on a customer list. Under no circumstances will telephone numbers be provided to anyone, even if you choose to have your name included on a customer list.

You must notify us if you choose not to have your customer information released. Please let us know of your decision as soon as possible by using one of the following options: call our Customer Contact Center at 1-888-460-4332; or complete the form below and submit it to us.

If we don't hear from you, your customer information will be included on future customer lists.

© 2004, Columbia Gas of Pennsylvania
All
Rights Reserved

Please check the appropriate box:

Do not release my usage informaton
Do not include my account information on any customer lists

Name on account:
Account number:
Service address:
(include City, State and ZIP)
Home Phone (include area code):
E-mail:
   
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