(A Joint Venture Company of RSPCL & Gail Gas Limited)
Online Application Form
Name of the Customer/ Company * :
Location/ Address of Plant * :
Contract Person * :
Telephone No. :
Mobile No. * :
E-mail * :
Type of Customer * :
Type of Industry * :
End Product Manufactured :
Quantity of Production :
Details of the alternate Fuel Used (Fill in the details given below:)  
Name of Fuel used. Gross Calorific Values
in Kcal per unit
Conversion Factor Quantity Consumed/day * Application Heating/power * No. of Working Hrs. Add
Do You have plan for expansion :
Mention Details/Qty
If Grid Power Available then Connected Load in KW :
Monthly Eletricity Bill (Unit) :
Cost of Electricity Bill (in Rs.) :
Are you willing to Natural Gas * :
Pressure requirement (kg /bar) :
Date on which Customer is ready to receive Gas :
Natural Gas Demand (SCMD) :
Peak Demand
Any other information :
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