By submitting this form, I authorize the agency responsible for qualifying me for benefits being received to release information on this application to Columbia Gas of Massachusetts. I authorize the administrator of the program checked to notify the company in the event that my benefits are terminated. I also understand that I must notify Columbia Gas if my benefits are discontinued. By submitting this form, I certify all information provided to be true.

Certifying documents

Contact us to submit an acceptance letter from a certifying agency to us.

Have an emergency?

If you smell gas, think you have a gas leak, have carbon monoxide symptoms or have some other emergency situation, go outside and call 911 and then our emergency number at 1-800-525-8222.