Your gas meter reading:

Your electric meter reading:

Date meter(s) read:

Your 10 digit NIPSCO account number:

Please provide the following contact information:

Last Name:

First Name:

Middle Initial (optional):

Street Address:

City:

State:

ZIP:

Mailing Address (if different):

City (optional):

State (optional):

ZIP (optional):

Home Phone # (optional):

Work Phone # (optional):

FAX # (optional):

E-Mail: