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Commercial and Industrial Overview

Nicor Gas
Non-Residential Service Application and Agreement

* Required

Name of Business:*
D.B.A (Doing Business As).:
Service address:*
Service City:*
Service State:*
Service Zip code:*
Billing address:*
Billing City:*
Billing State:*
Billing ZIP code:*
Area Code and Phone Number :*
Fax:*
E-Mail:*
Organized as a:*
Partnership Proprietorship
Business Description:*
SIC Code:
Number of employees:*
Tax I.D.
FEIN:*
State I.D.:
S.S.N:*
Do you own the property?*
No

If No, please include landlord information below:
Landlord Name:
Landlord Address:
Landlord City:
Landlord State:
Landlord ZIP code:
Area Code and Phone Number:
Lease agreement dates:
Start:
            mm/dd/yyyy
Stop:
            mm/dd/yyyy
Have you ever used Nicor Gas service before?*
No

If Yes, please include the following:

Previous Service Address:
Previous Service City:
Previous Service State:
Previous Service Zip code:
Previous Account Number :
Contacts
Name
Title
Owners (if applicable)
Officers (if applicable)
President (if applicable)
Person responsible for A/P
Guarantor name:*

By your clicking on “Send” below, you are certifying that all information provided above is true and correct, and that you are the Guarantor identified above, represent the business identified above, and the business intends to be bound by this Agreement and all applicable Gas Rates and Riders. You further understand that submitting false information or statements is punishable and may constitute a criminal offense under state, municipal, or federal law. In consideration for Nicor Gas providing natural gas and other services as requested in this Application, the business identified above unconditionally guarantees full and prompt payment to Nicor Gas for the cost of the natural gas and services provided pursuant to this Application and that you unconditional and personally guaranty such full and prompt payment.


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