Natural Gas Interest Form For South Rim

* Required

First name: *

Middle name:

Last name: *

Street address: *

City: *

Zip: *

Email address: *

Phone number: *

Are you interested in natural gas service at your home or business? *

What type of gas service would you be interested in? * (Please check all that apply) Residential Commercial Industrial I'm not interested

What is your current source of space heat? *

Please specify: *

What is your current source of water heat? *

Please specify: *

What appliances do you currently have in your home? * Furnace Water heater Stove Dryer Other

Please specify: *

If you have propane, is the fuel line black pipe or copper pipe? *

Please specify: *

If you have propane, is the fuel line in the front or back of your home? *

Please specify: *

What do you see as the benefits of having natural gas in South Rim?

What questions do you have about natural gas service at your home or business?

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