ACH Application

AUTHORIZATION FOR AUTOMATIC PAYMENT PLAN

"The Convenient, Easy Way to Pay Your Gas Bill"

How it works:

Each month your bank will automatically pay your gas bill from your checking or savings account. You save the cost of a check, postage, inconvenience, and the possibility of forgetting to pay. Join Today!

How to sign up:

1. Complete the authorization form below.
2. Allow up to 2 weeks for the processing of your application.

Warning, do not complete this form if you have already enrolled. Please contact customer service at 800-331-7396 M-F 8:00am - 4:30pm for further assistance.

Banking Information:

Bank Name:
Name Of Financial Institution

* Required

Please type your name exactly as it appears on your checking or savings account on the line below.

Bank Routing Number:
* Required

Bank Account Number:
* Required

Bank Accout Type: (Please Select One)

Checking

Savings

* Required

Ohio Gas Company Information:

Ohio Gas Company Account Number:
* Required

Date: 11/21/2024
Name On Gas Account

Address Where Gas Is Used * Required

City

State

Zip Code

Home Phone:
* Required

Cell Phone:
* Required

Please use a valid email address as Ohio Gas Company may use this to verify any data.

Email Address:

* Required * Please enter a valid email address.

Anti-Spam Question:

Is fire hot or cold?

* Required

Authorization Disclaimer:
By submitting this form I agree to the following statements. For my benefit and convenience you are hereby authorized to pay and charge my account for bills rendered by Ohio Gas Company provided there are sufficient funds in my account to pay said bills upon presentation. I agree to be bound by the financial institution’s rules governing checking and savings accounts.