Fill out this form to receive our senior citizen discount. Our senior citizen discount is for people ages 65 years and older and whose annual combined gross income of his or her household does not exceed $16,000.

NOTE: The information provided is subject to audit and verification as deemed necessary by Austell Gas System. The applicant agrees to notify the company immediately of any change in the circumstances that make the applicant eligible for the discount.

Please fill the form out below or, if you prefer, print and complete this form and send to:

Mail: Austell Gas System, P.O. Box 685, Austell, GA 30168

Night Drop Box: 2838 Joe Jerkins Blvd, Austell, GA 30106

Fax: 770-948-8644