Pooling Service Application

Pooling service requested:* Daily General Full requirements Local production Energy Choice

Application submitted by:*

Title:*

Email address:*

Phone number:*

Date submitted:

Business information

Complete legal name of firm:*

Federal tax ID:*

Unique Entity Identifier (UEI) (formally DUNS number):

Mailing address:*

City:*

State / Province:*

Zip code / postal code:*

Country (if foreign):

Business phone number:

Business structure

Legal structure:* Limited Liability Company (LLC) Corporation Parent Subsidiary Division Partnership Sole proprietor

Complete name of parent company (if applicable):

Officers, partners or proprietors

Name:

Title:

Phone number:

Other information

Type of business:*

State of incorporation:

Date of incorporation:*

Name of primary business contact:*

Title:*

Phone number:*

Email address:*

Name of person responsible for paying bills:*

Title:*

Phone number:*

Email address:*

Mailing address:*

City:*

State / Province:*

Zip code / postal code:*

Country (if foreign):

Trade references (3 required)

Company name:*

Contact name:*

Mailing address:*

City:*

State / Province:*

Zip code / postal code:*

Country (if foreign):

Company name:*

Contact name:*

Mailing address:*

City:*

State / Province:*

Zip code / postal code:*

Country (if foreign):

Company name:*

Contact name:*

Mailing address:

City:*

State / Province:

Zip code / postal code:

Country (if foreign):

Bank references

Bank name:*

Mailing address:*

City:*

State / Province:

Zip code / postal code:

Country (if foreign):

Phone number:*

History

Previous name of business:

Previous owner:

Previous address:

City:

State / Province:

Zip code / Postal code:

Country (if foreign):

Additional details

Tell us about your company and how you'd like to work with Enbridge Gas Ohio?

Anything else we should know?

Please include a check in the amount of $50 made payable to Enbridge Gas Ohio for the financial evaluation fee.

It is hereby warranted that the attached financial statements are a true representation of applicant's financial situation.

Applicant's signature attests financial responsibility and willingness and ability to remit amounts due in accordance with terms of any applicable agreements between applicant and Enbridge (dba Enbridge Gas Ohio) and/or with terms of any invoices rendered to applicant by Enbridge (dba Enbridge Gas Ohio). If applicant defaults on agreed upon payment terms, applicant agrees to pay interest per the terms of the contract on the unpaid balance in addition to collection costs, attorney fees and court costs, should be required to remedy the default.

The information provided on this form is for the purpose of determining applicant's financial stability and is warranted to be true. I/We hereby authorize Enbridge (dba Enbridge Gas Ohio) to investigate the references listed herein and to examine my/our credit history to determine my/our credit and financial responsibility.

Signature:* Please type full name for electronic signature.

Title:

Date:

Choose Your Province/State of Service

Choose Your Province/State of Service

Choose Your Province/State of Service

Choose Your Province/State of Service

Business information

Business structure

Officers, partners or proprietors

Other information

Trade references (3 required)

Bank references

History

Additional details

About Enbridge Gas

Doing Business With Us

Connect With Us

Contact Us

Billing options and assistance

Pay my bill

Read your gas meter

Understand my bill

Billing inserts

Billing and payment options for businesses

Budget Billing

Business information

Business structure

Officers, partners or proprietors

Other information

Trade references (3 required)

Bank references

History

Additional details