Service Line Application

Applicant Information

Project/Customer Name*

*required

Account Number

Contact Person*

*required

Title*

*required

Secondary Contact Person

*Type of Business

*required

SIC NAICS Code

Click here for a list of NAICS Codes

Service Address

Existing BuildingExisting ServiceNew BuildingAddition

*required

Street Address*

*required

City/Town*

*required

County*

*required

Located between these two intersecting roads:

Additional Directions

Mailing Information

Mailing Name

(if different than applicant)

Full Mailing Address

(if different than service address)

Building and Fuel Information

An application cannot be processed without this information.

Note: If any equipment will have alternate fuel capability (e.g. fuel oil, well gas, etc.), please note in the equipment listing.

Please indicate the delivery pressure for service that you are requesting:*

The normal delivery pressure for service provided by National Fuel to customers in New York and Pennsylvania is 7 inches water column (w.c.). Please note that the minimum allowable delivery pressure for service provided by National Fuel to customers in New York is 4 inches w.c.

General comments or specific requests

Please submit a site plan referencing the service address provided on this application to show the building layout and desired meter location. Please be sure to detail any underground obstacles that may be present (water, sewer, septic system, phone, etc.). Site plans can be mailed to the following addresses:

Date Foundation Complete:

For new construction only

Requested Meter Installation Date:

Please note the date requested must be at least 4 weeks from today

Requested Service Line Installation Date:

Please note the date requested must be at least 4 weeks from today

Equipment Information

YesNo

*required

Property Restoration Guidelines:

National Fuel will perform surface restoration when the service line is located within a public right-of-way. In all other cases, customers are responsible for surface refinishing, restoring lawns, shrubbery, driveways or walkways, and the repair of any damage to unmarked underground facilities that occur as a result of the natural gas service line installation.

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