Clark Gas Co.
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New Residential Customer Application - Contact Information Form

Please complete the following contact form and submit. We will call to verify and gather additional information. Thank you for choosing Clark Gas Company, serving Northwestern Alabama and South Central Tennessee.

  *required information
1 - Contact Information  
(all customers must complete) more
Name F / M / L *
Address *
City *
State / Zip *
Email *
Home Phone * (
Mobile Phone * (
  Rent Own Other     more 
2 - Propane Tank Information
Please enter any additional information here
Current or Previous Propane Supplier
Current Tank Percentage The current fill-level of my propane tank: %

I use propane for the following (please check all that apply)
Water Heater
Clothes Dryer
Questions? Please call 1-256-383-9421