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 gas 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 be half 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.

Required Field *

First Name:*
Last Name:*
Today's Date: (mm/dd/yyyy)*
Customer Name (on Utility Bill):*
Address:*
City:*
Pennsylvania
Zip Code:*
Phone: (ex. 111-222-3333)
Fax: (ex. 111-222-3333)
E-mail:

Service Account #:*

I have read and agree to the Terms and Conditions.
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