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Authorization

Empire Natural Gas will require your previous 12 months consumption and cost history from your local utility. You can authorize your utility to provide us with the information by filling out the following form OR downloading our Customer Authorization form for release of natural gas consumption and pricing information.

Please note: At present we are not accepting any residential customers

Name:

Company:

E-mail Address:

Phone Number:

Fax Number:

Current Utility:

First Account Number:
(POD ID for NYSEG Customers) ElectricNatural GasBoth


Service Address:

Second Account Number:
(POD ID for NYSEG Customers) ElectricNatural GasBoth


Service Address:

Third Account Number:
(POD ID for NYSEG Customers) ElectricNatural GasBoth


Service Address:

Comments or Additional Accounts:

By typing your initials in the box below, you are allowing Empire Natural Gas to view your previous 12 month natural gas consumption and cost records.

Initials