PO BOX 259
700 Farnsworth Road
Waterville, OH 43566


Phone: (419) 878-4972
Fax: (419) 878-7780

IN CASE OF EMERGENCY
CALL 419-878-4972


New Service Request - Residential

New customers must complete this form in its entirety:

Please call Waterville Gas at 419.878.4972 to determine the amount of the deposit required.

Full Name  
Service Address  
City, State, Zip  
Mailing Address  
City, State, Zip  
Service Start Date  
Property Type  
select
Home Phone Number  
Cell Phone Number  
Work Phone Number  
Email Address  
Employer  
Employer Address  
City, State, Zip  
Spouse Name  
Spouse's Employer  
Spouse
Work Phone number
Spouse
Cell Phone Number
Emergency Contact Name
(other than spouse)  
Emergency Contact
Relationship 
Emergency Contact
Phone Number  
   I hereby guarantee to the Waterville Gas Company the prompt and full payment of all charges for gas supplied by Waterville Gas to the above address beginning on the selected Service Start Date.