Request to Remove Riser/Gas Service Line

Request to Remove Riser/Gas Service Line

CLICK HERE TO PRINT FORM

Date:   _______________

I, __________________________ declare that I am the owner of the property listed below:

__________________________, _________________________

I wish the gas service line to be removed at the above location.  I understand that should I ever wish to have gas service again at this location, I will pay whatever the cost to install new service in full.

Property owner signature:  ____________________________

Office Use:  Service Order __________________ Picked up on: __________________

Please return completed form to:  P O Box 470, Raceland LA 70394 or 985-537-5282 (Fax) or e-mail to pchiasson@southcoastgasco.com