Service Application

Date service to begin

Name of Applicant

Spouse Name

SSN of Applicant

SSN of Spouse

Billing Address

City

State

Zip Code

Home Phone Number

Email Address

Service Location

Service Location Phone

Applicant's Employer

Employer Phone Number

Spouse's Employer

Spouse's Employer Phone Number

Premises to be used for:

Please check one Business Use Residence Landlord/Rental

Gas Appliances in Unit

Please check all that apply

Local Contact

Local Contact Phone

Comments and Special Instructions

As required by Federal Regulations, we are notifying you that an Excess Flow Valve (EFV) that meets all 49 CFR Part 192.381 requirements is available and can be installed per your request during the installation of your new service line.

An EFV is a device that is installed in the gas service line, below ground, after the curb stop. Its purpose is to automatically shut off the flow of gas to your house in the event of a service line rupture between the EFV and your gas meter. The EFV will not protect against slow leaks such as those caused by corrosion, loose fittings, or leaks beyond the meter (house piping).

The cost of an EFV installed is $50.00 plus tax. Since the service line from the curb stop to your point of use is your property and your maintenance responsibility, should this device fail and/or automatically shut off the gas flow to your meter, all expenses to restore gas flow will be your responsibility. The cost to reset or replace the unit should be within a range of $50.00 to $1,000.00, depending on circumstances such as time of day, time of year, location of the device, etc.

Please indicate below whether or not you desire to have an EFV installed in your new service line.

If you have any questions concerning this matter, please call our office at 1-304-866-4872. Our fax number is 1-304-866-4873 or you may email us at cvg@canaaanvalleygas.com

Do you wish to have an EFV installed in your new service line?

I/We hereby apply for gas service by meter, at the address listed above under the published tariff, rules and regulations of CVG now or hereafter in effect. I/We agree to pay the monthly service fee for such service at the published rates of CVG as they may appear from time to time, and further agree that this shall be a joint account. For a new service, I/WE AGREE TO PAY AT LEAST THE MINIMUM GAS BILL FOR A PERIOD OF THREE (3) YEARS FROM THE DATE SERVICE IS MADE AVAILABLE TO MY/OUR PROPERTY, REGARDLESS OF WHETHER I/WE ACTUALLY USE SUCH SERVICE. I/We certify that the above information is true and correct. By submitting this form electronically, I/We acknowledge and affirm that it shall have the same force and effect as if the form were signed personally by Me/Us.

Service Application

CVG Service Application