Authorized User Request

Elkton Gas is committed to maintaining the security and confidentiality of our customer’s account information. This verification process ensures we are taking all the necessary steps in safeguarding the confidential records of our commercial accounts.

Customer Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
I authorize Chesapeake Utilities to grant each of the following individuals access to the accounts listed below. I have provided their names and a pass code to be used to verify their Identity. For more than six account numbers or authorized users, please see the spreadsheet attached.
Account Numbers
Account Number 1
Account Number 2
Account Number 3
Account Number 4
Account Number 5
Account Number 6
Authorized User List
Name
Pass code
Name 2
Pass code 2
Name 3
Pass code 3
Name 4
Pass code 4
Name 5
Pass code 5
Name 6
Pass code 6
Customer Signature
Title

Complete By Mail (optional)

If you would prefer to send a physical copy of this application, you can download the below form and mail to us:

Download Form

Authorized User Request

Account Numbers

Authorized User List

Complete By Mail (optional)

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