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Gas Transport Supplier Authorization Form 



  1. The supplier listed below is authorized to make nominations on behalf of Customer for the account(s) listed below with Ameren Illinois.

  2. The supplier will be given access to all information that Ameren Illinois may provide from time to time on the USMS - Gas Transportation System regarding Customer’s account(s).

  3. The supplier has a relationship (contractual or otherwise) with Customer and is not necessarily a business party of Ameren Illinois. Ameren Illinois' obligations are to their customers and not their customer’s suppliers.

  4. Customer shall notify, in writing, Ameren Illinois in the event Customer terminates an existing relationship with the supplier.

Customer Information
* required information
Company Name: *
Contact First Name: *
Contact Last Name: *
Title: *
E-mail Address: *
Confirm E-mail Address: *
Account Number: *  Where is this?
Add Another Account Number

Account Number

Your ten digit account number located on your Ameren bill.

Supplier Information
* required information
Company Name: *
Contact First Name: *
Contact Last Name: *
Address: *
City: *

State: *
ZIP Code: *
E-mail Address: *
Confirm E-mail Address: *
Phone Number: *  555.123.4567
Rate Zone:*

What is my rate zone?
I authorize this supplier to include me in a pool group:*

What is a pool group?
I authorize this supplier to make bank transfers:*

What is a bank transfer?
I authorize the termination of the relationship with the previous supplier: *

A RG12 form must be submitted to Ameren if this agent/supplier will be collecting gas revenue tax for your account(s). If no form is received, Ameren will apply Gas Use Tax to your account(s). If you are exempt from Gas Use Tax, a RG61 is required. Please send the completed RG12 or RG61 form to Bob Cecil, Ameren Services, MC 212, P.O. Box 66149, St. Louis, MO 63166-6149.

Rate Zone

Rate Zone is the service territory in which your account resides. Zone I - formerly AmerenCIPS, Zone II - formerly AmerenCILCO and Zone III - formerly AmerenIP.

Your Rate Zone can be found on your Ameren bill under the Natural Gas Service Billing Detail.

Pool Group

Two or more accounts aggregated to achieve economies of scale in the nomination and balancing process.

Bank Transfer

Transfer of gas bank between similarly balanced accounts or pools.


Any person who submits false or inaccurate information as part of this form may be subject to fines and/or punishment pursuant to applicable federal and/or state laws and regulations.

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