Natural gas survey

First name

Last name

What is the address where you would like to receive natural gas service?

Address line 1

Address line 2

ZIP code

Phone number

Email address

Do you own or rent your home?

What type of energy do you currently use at home?

Are you interested in using natural gas?

Approximately how close does your home sit from the street? (In feet)

What's your home's avg. square footage?

Including yourself, how many people live in your household?

When would you like to start using natural gas?

What natural gas appliances are you interested in? Enter all that apply.

How old is your furnace?

How old is your water heater?

What's the best way for us to follow up with you?