Personal

First Name

Spouse Name

Service Address

Billing Address

Rate Plan

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Billing Options

Select from one or more of these additional convenient payment or billing options:

•   Printed Bill
•   Automatic Bank Draft
•   Internet Billing

Terms & Disclosures

Please Read the Following Statements:

• I hereby request that my gas marketer be changed to Walton EMC Natural Gas and I designate Walton EMC Natural Gas to act as my agent solely for the purpose of making this change of gas marketer. I understand that if this is more than a single switch in a 12-month period, I will be subject to a $7.50 charge by AGLC for switching and that there may be a charge if I elect after this switch to switch back to my current marketer.
• I understand that a service establishment fee may apply to new turn-ons.
• I authorize Walton EMC Natural Gas to obtain my credit information. I understand that, based on the information obtained by credit reporting agencies and other sources, I may be assessed a deposit or denied service by Walton EMC Natural Gas.
• Please read Walton EMC Natural Gas's complete Terms of Service.
• Please read Walton EMC Natural Gas's Disclosure Statement.
• I certify that I am over 18 years of age and that I am authorized to request service for this address.
• If I choose a fixed rate plan, I understand I cannot switch to a variable rate plan or different fixed rate plan until the term of the fixed rate contract is completed or an early termination fee may be assessed.

•   By checking this box, I confirm that I wish to sign up for service from Walton Gas.

If you are submitting this request prior to the 17th of the month, your gas service should be switched beginning the following month.

If you are submitting a request on or after the 19th of the month, your gas service may not be switched until the second month following your request.