Restrict Account Information
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UGI Customer Number / Account Number
(Value Required)
Email Address
(Value Required)
Full Name
(Value Required)
Company Name
(if applicable)
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
Service Address
Street Address
(Value Required)
City
(Value Required)
State
(Value Required)
Pennsylvania
Maryland
ZIP Code
(Value Required)
ZIP+4
Please add any pertinent comments or questions
(Limit: 325 characters)
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Restrict / Unrestrict Information on Customer Lists
I wish to exclude only my historical billing data from customer lists provided to customer choice suppliers.
I wish to exclude all account information included on customer lists that are available to customer choice suppliers.
I wish to exclude my account information from customer lists that are available to third parties (information will still be provided to customer choice suppliers).
Please remove any previous exclusions from my account.
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