Residential Gas Application | Ohio Valley Gas Corporation

OHIO VALLEY GAS CORPORATION/OHIO VALLEY GAS, INC

APPLICATION FOR RESIDENTIAL GAS SERVICE

*Requirements for this gas service application. Before beginning this application, you need to scan your current Driver’s License or another state- or government-issued photo ID and save it as a PDF file. You will be required to attach the PDF file at the end of the application. You can find an example of the required ID on the Indiana BMV Website. If you do not have a scanner, you can find scanning apps in your cell phone's app store. The scan must be clear and in focus to be accepted. If you can’t complete this form, contact your district office. Find your District Office.

All sections marked with an * are required.

Section 1 - Service Address

Select City of Service Address

Street Address

City

State

Zip Code

If you require assistance with this form, you can contact your District Office at (765) 825-1148 or (800) 326-1148.

If you require assistance with this form, you can contact your District Office at (260) 726-8114.

If you require assistance with this form, you can contact your District Office at (812) 268-6368 or (877) 884-6368.

If you require assistance with this form, you can contact your District Office at (812) 547-2397 or (877) 842-2397.

If you require assistance with this form, you can contact your District Office at (765) 584-5501 or (877) 853-5501.

Section 2 -Mailing Address (If Different)

Address

City

State/Province

Zip/Postal

Section 3 - First Applicant Information

Name

First

Middle

Last

Mobile Number

Alternate Phone Number

Email and Confirm Email

Confirm Email and Confirm Email

Driver License Number

Last 4 of SSN

Date of Birth

Emergency Contact Name (Not residing with you)

First

Last

Emergency Contact Phone Number

Relationship

Employment Section

I am

Employer Name

Employers Address

City

State/Province

Zip/Postal

Employers Phone

Years Employed

Section 4 - Second Applicant Info

Name

First

Middle

Last

Mobile Number

Alternate Phone Number

Email and Confirm Email

Confirm Email and Confirm Email

Driver License Number

Last 4 of SSN

Date of Birth

Emergency Contact Name (Not residing with you)

First

Last

Emergency Contact Phone Number

Relationship

Is Second Applicant Employed?

Second Applicant Employer Information

Employer Name

Employers Address

City

State/Province

Zip/Postal

Employers Phone

Years Employed

Section 5 - General Information

Do You Rent or Own?

Landlord Name

Landlord Phone Number

Connection Request

Requested Connection Date

Best Time For Connection

Section 6 - E-Delivery and Enroll in Direct Debit

E-Delivery of Bill

Enroll in Direct Debit

Section 7 - Required Attachments

You need to scan your current Driver’s License or another state- or government-issued photo ID and save it as a PDF file. If you do not have a scanner, you can find scanning apps in your cell phone's app store. The scan must be clear and in focus to be accepted. You will be required to attach the PDF file at the end of the application. You can find an example of the required ID on the Indiana BMV Website.

In drop a file box, attach drivers license or state ID.

Example for the Indiana BMV Website.

First Applicant Drivers License or State ID.

Maximum file size: 516MB

Second Applicant Drivers License or State ID.

Maximum file size: 516MB

Paperless Billing

Yes, I would like paperless billing.

Agreement

I hereby agree to pay OHIO VALLEY GAS CORPORATION/OHIO VALLEY GAS, INC. as described in its effective rate schedule(s) as they exist from time to time. I understand and will comply with the approved OHIO VALLEY GAS CORPORATION/OHIO VALLEY GAS/INC. General Rules and Regulations Applicable to Gas Service and acknowledge receipt of an OHIO VALLEY GAS pamphlet that describes my rights and responsibilities as a residential gas customer. I further acknowledge that a deposit will be required if I cannot prove that I am credit-worthy or do not pay my bills promptly. I hereby certify that the foregoing information is true to the best of my knowledge and belief. The installation of a meter by OHIO VALLEY GAS CORPORATION/OHIO VALLEY GAS, INC. shall constitute a contract for the service applied for.

Signature

Clear

After submitting the form, an OVG employee will be contacting the applicant to confirm the application, determine if a deposit is required, and set a time for the connection if required.

Ohio Valley Gas

OHIO VALLEY GAS CORPORATION/OHIO VALLEY GAS, INC

Section 1 - Service Address

Section 2 -Mailing Address (If Different)

Section 3 - First Applicant Information

Section 4 - Second Applicant Info

Second Applicant Employer Information

Section 5 - General Information

Section 6 - E-Delivery and Enroll in Direct Debit

Section 7 - Required Attachments

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My Residence

My Business

Corporate Office

Our Mission

Our Vision