Service Request Forms


Customer/Service ID:
Stop Service Date:
Business Name on Bill:
Old Address:
City:
State:	Arkansas Oklahoma
Zip:
	Service Address cannot be a P.O. Box.
Service Address:
City:
State:	Arkansas Oklahoma
Zip:
Phone:
E-mail:
Verify E-mail:

Mailing Address:
City:
State:	Arkansas Oklahoma
Zip:
Is service currently ON for the new location?	Yes No Unknown
	AOG will call to confirm schedule date/time if you select No.
Start Service Date:
Requested By:

Note: Oklahoma residents will be billed a $25 connection fee on all new accounts. Arkansas residents will be billed a $25 connection fee on all new accounts. In addition, a security deposit may be required for Oklahoma and Arkansas residents.