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Service Info Form

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*Indicates a required field.

*Company Name Requesting Service

*Corporate Address


*City

*State

*Zip/Postal Code

*Project Manager or Primary Contact


*Phone Number

Email Address


Service Location (Specify address, or if at a development site list Section, Township, and Range)


City

State

Zip/Postal Code

Estimated Volumes/Natural Gas Load (Specify units in MMBtu per day)


Max Hourly Requirement


Pressure Requirement (Specify PSI at burner tip or outlet side of meter)


In-service Date For Test Gas
Month Day Year

Facility Start Up Date
Month Day Year

Number of Months Facility Operates Per Year
(If seasonal, indicate months of operation)


Description of Project Services Available From CNGC
Project Feasibility Study
Confidentiality Agreement
Project Manager
Project Design and Pipe Installation
Facility Maintenance and Repairs
Gas Supply and Energy Management

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