AUTHORIZATION AGREEEMENT FOR PREAUTHORIZED PAYMENTS

CUSTOMER NAME _____________________________________________________________

INDIANA NATURAL GAS CUSTOMER NUMBER: ___________________________________________________________

I (WE) HEREBY AUTHORIZE INDIANA NATURAL GAS CORPORATION, HEREINAFTER CALLED COMPANY TO INITIATE DEBIT ENTRIES TO MY (OUR) [___]CHECKING[___]SAVINGS ACCOUNT (SELECT ONE) INDICATED BELOW AT THE DEPOSITORY NAMED BELOW, HEREINAFTER CALLED DEPOSITORY.

DEPOSITORY NAME______________________________________________________________

ADDRESS________________________________________________________________________

CITY _________________________________STATE ________________ZIP _______________

TRANSIT ROUTER/ABA NUMBER__________________________________

ACCOUNT NUMBER______________________________________________

NOTE: IF YOU ARE UNSURE OF THIS INFORMATION, SEND US A VOIDED CHECK FROM THE ACCOUNT AND WE CAN GET THE CORRECT BANK, ROUTING, AND ACCOUNT NUMBER FROM IT.

REOCCURRING:[___] MONTHLY[___] OTHER_________________________________

TYPE OF DEBIT:[___] VARIABLE [___] FIXED$_________________________

THIS AUTHORITY IS TO REMAIN IN FULL FORCE AND EFFECT UNTIL COMPANY AND DEPOSITORY HAS RECEIVED WRITTEN NOTIFICATION FROM ME (OR AUTHORIZED PERSON) OF ITS TERMINATION IN SUCH TIME AND IN SUCH MANNER AS TO AFFORD COMPANY AND DEPOSITORY A REASONABLE OPPORTUNITY TO ACT ON IT.

NAME(S) PRINTED:

____________________________________________________________

TITLE (IF BUSINESS ACCOUNT):

___________________________________________________

SIGNED: ______________________________ DATE:_________________

SIGNED: ______________________________ DATE: ________________

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