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Landlord / Property Owner Service Notice and Agreement 6700 5-17

By submitting this Landlord/Property Manager Natural Gas Service Agreement (“Agreement”), you acknowledge and agree that Nicor Gas may place natural gas utility service (“Service”) for the premise(s) covered by this Agreement on a going forward basis in your name and continue Service to the premise when a tenant who had Service in the tenant’s name vacates the premise and there is no customer of record with such Service extending until such time that (a) Nicor Gas commences Service to a tenant leasing such premises or (b) Nicor Gas disconnects Service at such premises after being notified by you to make such disconnection. You further agree to be fully responsible for payment of any and all Service at or to the premise when Service is in your name.

Landlord / Property Owner Service Notice and Agreement 6700 5-17 Required Fields (*) must be filled in.
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Contact Information

Your Name*

Please select the option that best describes your status* Land/Property Manager Property Management Company

Landlord/Property Manager Contact Information (Address and Contact Information May Not be the Same as the Address(es) of the Premises Covered by this Agreement):

Address Line 1*:

Address Line 2:

City*:

State*:

ZIP Code*:

Mailing Address (if different):

Address Line 1:

Address Line 2:

City:

State:

ZIP code:

Best Contact Method

Email*:

Phone Number*:

Name/Title:

Identification

*Please enter at least one form of identification (If you cannot provide one of the listed forms of identification, please contact us at 630.388.3041 to discuss submission of acceptable identification).

State Issued Driver's License Number:

Federal Tax ID Number:

State Issued Identification Card Number:

Social Security Number:

Locations

List all premises that you own or manage and receive Service that are to be covered by this agreement:

Location #1:

Premise Address*:

ZIP code*:

City*:

Gas Meter Number*:

Location #2 (if applicable):

Premise Address:

ZIP code:

City:

Gas Meter Number:

Location #3 (if applicable):

Premise Address:

ZIP code:

City:

Gas Meter Number:

Location #4 (if applicable):

Premise Address:

ZIP code:

City:

Gas Meter Number:

Location #5 (if applicable):

Premise Address:

ZIP code:

City:

Gas Meter Number:

If you own more than 5 locations that should be covered by this agreement, please call/email us to confirm.

You acknowledge and agree that this Agreement is also subject to all terms and conditions for Service in Nicor Gas tariffs on file with the Illinois Commerce Commission, which include but are not limited to terms and conditions that all meters, regulators and other facilities placed on the premises covered by this Agreement for the purpose of rendering Service to said premises, whether inside or outside of any building on the premises, shall be and remain the property of Nicor Gas. The properly authorized agents of Nicor Gas shall at all reasonable hours have free access to the premises for the purpose of inspecting the installation and of reading, examining, repairing, or removing Nicor Gas’ meters or other property. You further acknowledge and agree that, in the absence of an agreement with Nicor Gas to place Service in your name between tenants, Nicor Gas may discontinue Service to the premises when there is no customer of record regardless of time of year or weather conditions. If there is no heat or if your premises are not properly winterized, there is the potential that water pipes or fixtures may freeze and burst, resulting in personal injury or property damage for which Nicor Gas will not be held liable. Acknowledged and agreed by authorized representative of Landlord/Property Manager:

If a tenant moves out would you like to have the natural gas account put in your name between tenants?* Yes No

RETURN TO: Nicor Gas Customer Contracts Department P.O. Box 190 Aurora, IL 60507-9980 Fax: 630.305.0288

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Landlord / Property Owner Service Notice and Agreement 6700 5-17

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