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Customer Registration Form

Customer shall complete and submit this Customer Registration Form in accordance with the Online Service Agreement. If you have any questions or want to access Customer Login on a trial basis, please call Customer Service at 615-595-2878 or email eaccountservices@atmosenergy.com.

For purposes of the Customer Registration Form and Online Service Agreement, the term "Customer" shall be defined as parties subscribing to services provided by Atmos Energy Marketing, LLC. Unless defined in this Customer Registration Form, defined terms herein shall have the meanings ascribed to them in the Online Services Agreement.

Customer *

Customer contact listed below shall serve as sole point of contact regarding modification of the Authorized Users and will have complete access to all areas of Online Services.

Contact Name *

Email Address *

Phone No *

Fax No

Mailing Address 1 *

Mailing Address 2

City *

State *

Zip Code *

By completing and submitting this Customer Registration Form, you individually or the party you are authorized to represent (in which case you represent and warrant that you are so authorized) ("you" or "your") agree to the terms and conditions of the Online Service Agreement, the Viewing and Usage Agreement and the Legal Statement. Upon acceptance by AEM, you (and each Authorized User nominated below) will be issued an individual Logon ID and Password.

Additional Authorized User Information

Additional Authorized User Information

Name

Name

Company

Company

Email Address

Email Address

Phone No

Phone No



I have read and agree to the following:

Online Service Agreement

Viewing and Usage Agreement

Legal Statement



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