Once you submit the for below you will be sent a request to send a photo of your state identification card.

First Name (required)

Last Name (required)

Service Address (required)

City (required)

Zip (required)

Email (required)

Phone number (required)

Preferred Method of Communication

Email

Phone

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Please share additional information regarding your inquiry

Do you plan to rebuild at the location(s) with natural gas?

Yes

No

Are you the owner of the property

Yes

No

I hereby authorize Okaloosa Gas District to proceed with the cutting and capping of the service line(s) at the designated location(s) within the next 5 to 10 business days. I understand that this process involves abandoning the existing piping in the ground and that the District will not perform a full removal of the gas lines. To confirm job completion, please contact Okaloosa Gas at 850-729-4700.

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Review Electronic Records and Signatures Policy (required)

Read our Electronic Record and Signature Disclosure

I agree to use electronic records and signatures

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