Once you've completed the form, fax or mail it to:
790 Windmiller Dr.
Pickerington, Ohio 43147
Fax: 614-856-3301
Toll Free: 1-800-977-VESI

For our Customer Choice Program, dial ext. 221

- You will continue to receive quality natural gas
- Your utility will continue to deliver your natural gas, read your meter and service your account
- You will continue to receive your billing statement from your utility and make payment
- You will call your utility in case of an emergency

Residential Natural Gas Supply Agreement

Customers Acceptance Form

I acknowledge that I am the account holder, a person legally authorized to execute a contract on behalf of the account holder, or the spouse of the account holder. I understand that by signing this Agreement, I am switching the gas supplier for this account to Volunteer Energy Services, Inc. I understand that has purchased for this account by Volunteer Energy Services, Inc. will be delivered through my current utility’s delivery system. The account holder, or the person who signed this contract on behalf of the account holder, has (30) days after today to cancel this contract for any reason through written or verbal notification to Volunteer Energy Services, Inc. By signing this agreement I agree to the terms and conditions on the reverse side of this agreement.

Customer Signature:___________________________________ Date:_______________________

Print Name:______________________________________ Title:___________________________

Customer Name (on Utility Bill):______________________________________________________

Service Address:_________________________________________________________________

City:____________________________________ State:________________ Zip:_______________

Phone:___________________ Fax:____________________ E-mail:________________________

Gas Utility: ____ Columbia Gas of Pennsylvania ____ Other ____

Service Account:______________________________ (If more than one account include worksheet)