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Thank you for your interest in becoming a Daniels Natural Gas customer. Generations of Connecticut families have come to depend on Daniels' outstanding service. Please assist us in determining the right service for you by filling out this simple online form. Information indicated in • red is required.

•Your Name:
•Address:
Address 2:
•City/Town:
State:	Serving Central Connecticut Only (see map)
Zip:
•Phone:
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•Confirm Phone:
Cellphone:
•Email Address:
Work:
Work Address:
City/Town:
Work Phone:
	How may we serve you? Please tell us so we may best address your area of interest.
• Comments:

I hereby state that the information I have provided above is true and accurate to the best of my knowledge. I am requesting natural gas service (or an equipment quote) from Daniels Energy and agree to provide appropriate information to initiate the process.

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