Please note: All fields marked in red with an asterisk (*) are required.

Basic Information

Last name*

First name*

MI

Street address*

City*

State*

Zip code*

E-mail address

Social Security number
 -   -   

Home phone*
 -   - 

Employer name

Contact phone number
 -  - 

Have you had previous natural gas service with CenterPoint Energy?
Yes     No

New Service Information

First date you are responsible for utilities*

New service street address*

City*

State*

Zip code*

Is this a joint account?
Yes     No

If yes enter the joint account info

Last name

First name

MI

Do you own or rent the property for which you are requesting service?*
Own     Rent

If you rent, please provide the following:

Owner's last name

Owner's first name

MI

Owner's street address

Owner's City

Owner's State

Zip code

Alternate Mailing Address

If you have alternate mailing address, please provide the following:

Alternate mailing street address

Alternate City

Alternate State

Zip code

Additional Services

I want to add the following services:

Automatic Bank Draft

Budget Plan

Home Service Plus® Repair Plan

Other items you may add to the plan

A/C

Dishwasher

Refrigerator

Clothes Washer


Register me for secure access to My Account Online using the e-mail address above for my user id.

 

Additional Comments