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 and to confirm reading date.
Service Information
Service Address
City
State
Zip
Service Start Date
Property Type
Contact Info
First and Last Name
Email Address
Mailing Address
City
State
Zip
Daytime Phone
Cell Phone
Work Phone
Employer Information
Name of Employer
Employer Phone
Additional Resident Information
Additional Name
Additional Resident Employer
Work Phone
Cell Phone
Emergency Contact
Emergency Contact Name
Emergency Contact Relationship
Emergency Contact Phone Number
I hereby guarantee the Waterville Gas Company the prompt and full payment of all charges for natural gas to the above address supplied by said company.

Service Information