Turn On Natural Gas Service

All information collected from this form is strictly confidential.

* = indicates required field


GENERAL INFORMATION

*Name to Appear on Account:
Date of Birth (mm/dd/yyyy):

The next four fields are vital in completing your application.  We will be unable to complete the online 
turn on process without at least one of the following items.  If you cannot provide this information, 
please visit one of our Customer Service Centers.  

*Social Security Number: Format(123456789)
Driver's License:
State in which License was Issued:
DPW Number:
Non-Driver's License:
New Home Phone Number:
*Daytime Phone Number: Format(555-555-5555)
PGW Account Number, if Applicable:
*E-mail Address:
 

NEW ACCOUNT INFORMATION

*Premise (New Service Address):
Apartment Number/Floor:
*Zip:
*Is this the billing address?
Yes No
If no, please enter the billing address:
 
City:
State:
Zip:
If this is a rental property, please provide the current Landlord or Agent address if known:
 
 
Zip
 
If available, please supply the following information:
Full name of last occupant or Landlord:
Landlord phone number:
 

The following information will be used to determine if you may be eligible for other special assistance programs. You may be entitled to more than one.

*How many occupants will be in the household?  *I prefer not to/refuse to provide my household occupancy information (If applicable, check the box)
How many of the household members are 18 years old or younger?  
How many of the household members are over 65 years old? 
*What is the total gross (before taxes) income for all members of the household?  $ *I prefer not to/refuse to provide the income information (If applicable check the box)
  

Would you like to be placed on an Easy Way Budget Plan?

Yes No

 Would you like to receive information about PGW's Parts and Labor Plan?

Yes No

TURN ON INFORMATION

It may be necessary for a PGW representative to visit your home to complete the turn on.  In the fields below, please provide your choice of three convenient dates (Monday through Saturday only) on which to visit.  We will do our best to honor one of the selected dates and contact you by e-mail to confirm.  

Effective Date of Lease/Settlement (mm/dd/yyyy):

*Move-In Date - date you are requesting gas (mm/dd/yyyy):

*2nd Choice - if PGW cannot oblige first date (mm/dd/yyyy):
*3rd Choice - if PGW cannot oblige first & second dates (mm/dd/yyyy):

Customers are required to provide at least seven days notice when requesting a turn on of gas service.
Failure to provide ample notice may result in the inability to oblige any of the choice dates. 

 

GAS CHOICE

Pennsylvania’s Customer Choice Program allows customers to choose a natural gas supplier other than PGW. As part of the program, PGW is required to provide licensed natural gas suppliers with customers’ available account information, including name, address, account number, and natural gas usage history. Please note that your telephone number will not be provided to suppliers. This account information allows suppliers to provide you with information about their services, and may make it easier for you to choose the right supplier for your needs.

However, you have the right to opt out of having either your natural gas usage information, or both account and gas usage information released to gas suppliers, by selecting one of the following options:   

Release account and gas usage information
Release account information, but do not release gas usage information
Do not release any account or gas usage information

EMPLOYMENT INFORMATION

Occupation:
Employer:
Number of Years Employed:
Employer's Phone:
Business Address:
 
City:
State:
Zip:
 
It may be necessary for PGW to contact you during daytime hours.
Please indicate how you would like to be contacted:
If you are moving from one Philadelphia premise to another, please complete both a turn on and turn off form.
 
Please call PGW at 215-235-1000 if you do not receive an e-mail or phone call from us within two business days.