PPO AGREEMENT

Graysville Gas and Water Policies, Procedures, and Ordinances Agreement

Service Address*

Customer Number*

By providing your initials in the designated boxes and signing on the signature line at the bottom of this document you are acknowledging and consenting to our policies procedures and ordinances. In the event of any future disputes regarding your services this form will serve as a reference.

blank* Turn off anything within your home that uses the services BEFORE the technician arrives to turn on your gas and/ or water. Our technicians are out in the field each day, and it is possible your request could be completed quickly.

blanks* If your WATER meter indicates any water flow during the turn on process and NOBODY is present at the property, it WILL NOT be left in the on position as it may potentially cause damage to your property. However, it will be unlocked and switched to the OFF position, with our technicians notifying you either through a hanger left at your property or via a call/email from our office. Please note that if the technician is required to return, fees may apply

blanks* If your GAS meter indicates any gas flow during the turn on process and NOBODY is present at the property, it WILL NOT BE LEFT ON OR UNLOCKED due to PSC gas safety requirements. Our technicians will notify you either through a hanger left at your property or via a call/email from our office. Please note that if the technician is required to return, fees may apply.

blank* If your water heater or furnace has a pilot light the customer is responsible for getting in touch with a certified gas master plumber to light it or get the management company/owner to do so. Most newer units have an auto start pilot.

blank* When you vacate a property that uses our services you are required to complete a request to final service document to close the account properly. This can be found online or in the gas and water office. If the account is not closed correctly when the property is vacated there could be charges placed on the customer and / or the property.

blank* Services will be disconnected for any balance not paid in full by the 25th of the currentbilling month. If your services are interrupted for nonpayment at any point, there will be securitydeposit(s) added to the account and required to be paid in addition to the balance due for servicesto be reconnected. Deposits are not included in the activation fee(s) paid to start an account

Printed Name*

Signature*

Date*

Date

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.