Monthly Metered Natural Gas Supplier (MMNGS) Application and Credit Application

Completion Instructions

Applications for MMNGS service must be received at the address shown below at least 30 days prior to the first calendar day of the desired start month.

1. Complete entire application, filling in all spaces. If unclear on any part of this MMNGS application, call (716) 857-7538 for assistance.

2. Attach a listing of all NFGDC end-users which would be in the MMNGS Group - include each end-user's complete business name and NFGDC account number.
   NFGDC end-users:

3. Include your $500 non-refundable application fee.

4. Mail or fax the completed MMNGS Application and End-User Listing to:

   National Fuel Gas Distribution Corporation

   Penny Donaldson

   Credit & Receivables Management

   6363 Main St

   Williamsville, NY 14221

   Fax #: (716) 857-7439

Upon receipt of your completed MMNGS Application and End-User list, we will advise the amount of security deposit required and provide you with Agreements to sign and return.

Name of Business:*

*required

Address:*

*required

Billing/Mailing Address:*

*required

YesNo

*required

CorporationLimited Liability CompanySole ProprietorshipSchool or School DistrictChurch or Religious InstitutionNot-for-Profit OrganizationPartnershipLimited PartnershipMunicipal EntityMunicipal AgencyMunicipality

*required

OFFICERS / PRINCIPALS OF BUSINESS APPLICANT

Home Address:*

*required

Home Address:*

*required

Home Address:*

*required

ADDITIONAL APPLICANT INFORMATION:

YesNo

*required

YesNo

*required

When do you wish to initiate services as a Monthly Metered Natural Gas Supplier?*

*required

YesNo

*required

BANK REFERENCES:

Address & Branch:*

*required

Address & Branch:*

*required

ADDITIONAL CREDIT / TRADE REFERENCES:

Address:*

*required

Address:*

*required

Address:*

*required

Remember to include your $500 non-refundable application fee. Your application will not be processed until this fee is received.

The undersigned hereby authorizes National Fuel Gas Distribution Corporation to make whatever credit inquiries it deems necessary in order to process this credit application; regarding any credit review or the collection of any debts accrued as a result of any credit extended as a result of their reliance on the information provided on or obtained from credit references given on this application. In addition, the undersigned hereby authorizes and instructs any person or credit reporting agency to compile and furnish National Fuel Gas Distribution Corporation any information it may have or may find necessary to obtain in response to requested credit inquiries. The undersigned further asserts that they have the authority to grant the permission to relinquish the requested information.

Signature

sign after printing

Signature

sign after printing

Δ