COMPANY INFORMATION

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FAX to 817-274-4724 Attn: Customer Service

Part 1 - Company Information:
Name: ___________________________________________	Phone Number: ________________________
Contact: ___________________________________________	E-mail Address: ________________________
Title: ___________________________________________	Fax Number: ________________________
Street Address: ___________________________________________	P.O. Box: ________________________
City: ___________________________________________	State: ________________________
Zip: ___________________________________________

Part 2 - Gas Usage Information:
Facility Name: ___________________________________________	City: ________________________
Local Distribution Co.: ___________________________________________	State: ________________________

Interstate Pipeline(s): _________________________________________________________________________

Describe your business: _________________________________________________________________________ _________________________________________________________________________

Market conditions that affect your business: _________________________________________________________________________ _________________________________________________________________________

Total Monthly Usage:	Total Daily Usage:
	Highest Usage Month:	Lowest Usage Month:
January ________________	Monday ________________	Monday ________________
February ________________	Tuesday ________________	Tuesday ________________
March ________________	Wednesday ________________	Wednesday ________________
April ________________	Thursday ________________	Thursday ________________
May ________________	Friday ________________	Friday ________________
June ________________	Saturday ________________	Saturday ________________
July ________________	Sunday ________________	Sunday ________________
August ________________	Total ________________	Total ________________
September ________________
October ________________
November ________________
December ________________	Historical Peak Day:	________________
Total ________________	Total Days Shut Down Annually:	________________

Please check appropriate space for volume units used

Ccf or Therms__________

Mcf, Dth or MMBtu__________

Gas used for (%)

Space Heat____%

Boiler Heat____%

Process or Feedstock____%

Other___%

Describe Other:_______________________________

Alternate fuel, if any:________________________________________________________

 

 

Part 3 - Current Supply Information (Optional):
Current Supplier: ___________________________________________	Contract Expiration Date: ___________________________________________
Delivery Point : ___________________________________________	Firm or Interruptible? ___________________________________________
Maximum Daily Take: ___________________________________________	Mimimum Daily Take: ___________________________________________
Demand Charge: ___________________________________________	Commodity Charge: ___________________________________________
Index Used (if any): ___________________________________________	Transport Charge: ___________________________________________

Other contract terms: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________

Other comments: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________

Please FAX to 817-274-4724 Attn: Customer Service