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Your Information Mandatory fields are designated with a *

* Your Name
(Full Name)

Please enter valid customer name

* PGW Account Number
(where credit is to be applied)

Invalid PGW Account Number

Please enter valid account number

* Address
(where credit is to be applied)

Please enter valid address where credit is to be applied

* City

enter valid city

* State

enter valid state

* Zip

enter valid zip

* Address
(where equipment was installed)
Same address as credit is to be applied

Please enter valid address where equipment was installed

* City

enter valid city

* State

enter valid state

* Zip

enter valid zip

* Phone

Please enter valid phone number

* Email

Please enter valid email

Landlord Rental License ID
(if applicable)

Installer Information

* Installer
Name

Please enter valid installer name

* Installer
Phone

enter valid phone number

* Installer
Address

Please enter valid address

* City

enter valid city

* State

enter valid state

* Zip

enter valid zip

* Date Of
Installation

enter valid date

Equipment Details

* Make

* Model

BTU Input

Efficiency Rating

Number of apartments (if applicable)

Please enter valid number

* Do you plan on converting any other
appliances to natural gas within this year?

Please Select At Least One

Please attach a copy of your signed contract and a paid in full invoice outlining the equipment details and all work completed.

If you are using a tablet or smart phone to submit your application, please take a picture of your documents and upload them in one of the below file formats.

Attachment Size and Type *
Individual attachment size not to exceed 2MB and total attachment limit is 10MB.
Only .gif, .jpg, .png, .pdf, .txt, .bmp, .doc , .docx and .jpeg file types are allowed.

Please attach valid file