Request New or Transfer Existing Service

Person Requesting Service(Value Required)

Preferred Contact Method(Value Required)

Preferred Contact Method Mobile Phone
Alternate Phone
Email

Mobile Phone

Alternate Phone

If provided, may we use your Mobile Phone number to contact you?

If provided, may we use your Mobile Phone number to contact you? Yes
No

SSN(Value Required)

( If you do not want to provide it online, please call us)

Email(Value Required)

Address of property to be served by UGI

Street Address(Value Required)

City(Value Required)

State(Value Required)

ZIP Code(Value Required)

ZIP +4

Do you own or rent the property?(Value Required)

Do you own or rent the property? Own
Rent

Landlord Information

Landlord's Name for Rental Property

Mailing address for Landlord

City

State

ZIP Code(Value Required)

ZIP +4

Phone

Billing Address

Use my Service Address as my Billing Address

Use my Service Address as my Billing Address Yes
No

Street Address(Value Required)

City(Value Required)

State(Value Required)

ZIP Code(Value Required)

ZIP +4

If you have multiple accounts with UGI, does this address apply to all your UGI accounts?

If you have multiple accounts with UGI, does this address apply to all your UGI accounts? Yes
No

You may be eligible for a security deposit waiver. View Customer Assistance Income Guidelines to determine eligibility. If income eligible, would you like to receive a deposit waiver form?

You may be eligible for a security deposit waiver. View Customer Assistance Income Guidelines to determine eligibility. If income eligible, would you like to receive a deposit waiver form? Yes
No

Effective Date / Access Information

Date Requested(Value Required)

(use MM/DD/YYYY such as 01/21/2025)

If you have previously had service from UGI please enter the address below (Limit: 150 characters)

If the service is off, please provide how / when we can gain access to the property (Limit: 250 characters)

If your current account qualifies, are you satisfied with using an estimated read for your final bill/transfer of service?

Yes

No

What should we do with your existing service(s)?

What should we do with your existing service(s)? End service at the address listed as current and start service at my new address.
Keep both the listed address and the new address as active services.
End service at the address listed. I do not need UGI service at my new address.

Please be sure the information entered above is correct. The form you are about to submit will be encrypted for privacy.

Request Electric Service

Person Requesting Service(Value Required)

Preferred Contact Method(Value Required)

Mobile Phone

Alternate Phone

If provided, may we use your Mobile Phone number to contact you?

SSN(Value Required)

Email(Value Required)

Address of property to be served by UGI

Street Address(Value Required)

City(Value Required)

State(Value Required)

ZIP Code(Value Required)

ZIP +4

Do you own or rent the property?(Value Required)

Landlord Information

Landlord's Name for Rental Property

Mailing address for Landlord

City

State

ZIP Code(Value Required)

ZIP +4

Phone

Billing Address

Use my Service Address as my Billing Address

Street Address(Value Required)

City(Value Required)

State(Value Required)

ZIP Code(Value Required)

ZIP +4

If you have multiple accounts with UGI, does this address apply to all your UGI accounts?

You may be eligible for a security deposit waiver. View Customer Assistance Income Guidelines to determine eligibility. If income eligible, would you like to receive a deposit waiver form?

Effective Date / Access Information

Date Requested(Value Required)

If you have previously had service from UGI please enter the address below (Limit: 150 characters)

If the service is off, please provide how / when we can gain access to the property (Limit: 250 characters)

If your current account qualifies, are you satisfied with using an estimated read for your final bill/transfer of service?

What should we do with your existing service(s)?