Citizens Conversion Contract for Natural Gas Service Request Form

* Required Fields


*Name:
*Address:	*City:
*State:	*Zip Code:
*Email:
*Day Phone:	*Evening Phone:

1. I agree that, as a condition of Citizen Gas installing gas service to my property for the following purposes, I will begin using gas supplied by Citizens Gas within six months of the date the gas service to my property is installed. 100 feet of gas service piping at no charge for Heating (furnace).* 50 feet of gas service piping at no charge for Water Heating. 150 feet of gas service piping at no charge for Heating (furnace) and Water Heating. To qualify for free footage, the Heating (furnace) must be the primary natural gas source of energy. A natural gas Heat Back-up source does not qualify for free footage per I.U.R.C regulations. Type of pipe used to accept natural gas: (Please select one.)Black 6”CSST/Flex 2 lbs
2. In exchange for my promises, Citizens Gas promises to furnish, install, own and maintain all piping and other appurtenances to supply service from the gas main up to the outlet of the meter at my property. Citizens Gas will remain the owner of the gas service from the main to the outlet of Citizens Gas’ meter.
3. I further agree to the following: a. to abide by Citizens Gas’ terms and conditions of gas service, including the rates, rules and regulations as the same may be approved by the Indiana Utility Regulatory Commission and the rules and regulations of the Indiana Utility Regulatory Commission which apply generally to the provision and receipt of utility service; b. to grant an easement over my property in favor of Citizens Gas, for the purpose of laying, maintaining, metering, repairing, and replacing the natural gas line, servicing my property or the adjoining property; c. to make payment to Citizens Gas in the amount of $9.12 per foot to compensate Citizens Gas for the cost of the gas service piping if I fail to use gas supplied by Citizens Gas, for the purposes designated in paragraph one above, within six months of the date the gas service to my property is installed; and d. to pay all reasonable attorneys’ fee or other costs of collection and all reasonable costs incurred by or on behalf of Citizens Gas to enforce the terms and conditions of this contract in the event of my breach of this agreement.
4. If I fail to use service as promised AND I pay the compensation noted above in paragraph 3(c), I understand that I may receive a full refund if I subsequently use gas supplied by Citizens Gas at this address as indicated in paragraph one, within 12 months of the installation of my gas service line. After the passage of 12 months, I understand that I will not be entitled to a refund of any portion of my payment.
5. I further acknowledge and agree that Citizens Gas is under no obligation, nor can it be held liable for any damages for not serving my property, until such time as the gas distribution mains have been installed and gas is available for general use for the area in which my property is located.