Customer Service Request Entry Form
Service Request Type:  Start Service         
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Customer Information
Address Information
Service Date
Comments
Summary
To process your request with Elizabethtown Gas, please provide the information below.
A customer service representative will contact you within one business day to obtain any additional information needed and finalize your service request.
Requests are processed Monday through Friday between the hours of 8 a.m. and 6 p.m., EST.

Primary Customer Information
First Name* Middle Name Last Name*

Best Time To Call* Main Contact*
Home Phone Cell Phone
Work Phone Other Phone

Email Address*  
Confirm Email Address*