Customer Service Request Entry Form
Service Request Type:  Transfer Service         
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Customer Information
Stop Service Date
New Address Information
Start 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.

Customer Information   
Account #*  
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*