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Residential Builder Request Form

1 - Front Left corner 8 - Front right corner 2 - Left side front corner 7 - Right side front corner 3 - Left side back corner 6 - Right side back corner 4 - Back left corner 5 - Back right corner
Company/Billing Information
  •  example: 555-555-5555
 
New Service Information
  • In City Limits?
  •  



  • Please enter orders at footer with an accurate need date. Piedmont’s goal is to install new service lines after the site ready date and by the need date.
    Date site ready – Meter location identified and no obstructions from street to meter location. Site is at final grade and walls are up.
    Date needed – The date you would like the gas service installed.
    Date Closing – The date on which ownership of the property is transferred to the buyer.
  • RadDatePicker
    Open the calendar popup.
  • RadDatePicker
    Open the calendar popup.
     
  • RadDatePicker
    Open the calendar popup.
     
  • Check All That Apply
  • Please indicate the number of each type of equipment
  •  
  •   Gas Heat
  •   Gas Water Heat
  •   Tankless Water Heat
  •   Gas Range
  •   Gas Logs
  •   Gas Lights
  •   Gas Grill
  •   Gas Dryer
  •   Generator
  •   Pool Heater
  •   Gas Assisted Heat Pump
  •   Other
  •   - or , not allowed
  • meter set
  • Important: Please check the correct structure type and service location number in the fields below. Service may be subject to charge depending on the load and service length. Single family meter locations beyond 2 or 7 may be subject to charge.
  •  
  •  Click on the image below to set the service location
  •  
    service location
     
  • Select One  
  • Do you own house   Apartment
  • Do you own house   Condo
  • Do you own house   Single Family
  • Do you own house   Townhome
 
Site Contact

 
Additional Services
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