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Name:
Submitting as:
Email Address:
Service Address:
City, State Zip
Telephone (home):
Telephone (work):
Billing Address:
City, State Zip:
S.S. No./Tax ID:
Drivers Lic.#/St:
Date of Service Request:
Location Type
Usage Type


By submitting this application, I represent that said premises is occupied as the location type listed above, and that gas shall be consumed for the usage type listed above only and agrees to take and use the same and to pay for the gas and service supplied at the said premises or any other premises at established rates. Applicable to this class of service, as bills are rendered therefore, until written notice is given by the applicant to discontinue the supply and applicant agrees to the terms, rules and regulations that are on file and available for review or inspection at the Conroe office.

Applicant affirms that he/she has read this application for service and that the information contained herein is true and correct. (Warning: Giving a false written statement to obtain gas service is a Class "A" Misdemeanor, punishible by a fine and/or imprisonment). (Section 32.32 Texas penal code).

Tap and Meter Fee: $860.00
Excess Flow Valve $225
Optional Yard Line Installation by LDC -- Call Office for Rates
Deposit: $210.00 (Residential)
$500.00 (Commercial)
Propane Conversion special pricing $560.00 + $225.00 (Excess Flow Valve) = $785.00

Please deliver the necessary amount to:
LDC, llc
620 Longmire Rd
Conroe, TX 77304

**Deposit, Application, and Tap and Meter fees MUST be received prior to service being initiated.**



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