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Gas Transport Customer Agent/Broker Authorization 
 
  1. The agent/broker listed below is authorized to make nominations with Ameren Missouri on behalf of Customer for the account(s) listed below.

  2. The agent/broker will be given access to all information that Ameren Missouri may provide from time to time on the Gas Choice Portal regarding Customer’s account(s).

  3. The agent/broker has a relationship (contractual or otherwise) with Customer and is not necessarily a business party of Ameren Missouri. Ameren Missouri’s obligations are to their customers and not their customer’s brokers.

  4. Customer shall notify, in writing, Ameren Missouri in the event Customer terminates an existing relationship with the agent/broker.



Customer Information
* required information
Company Name: *
Contact First Name: *
Contact Last Name: *
Title: *
E-mail Address: *  name@domain.com
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.

                        
Agent/Broker Information
* required information
Company Name: *
Contact First Name: *
Contact Last Name: *
Address: *
Address:
City: *

State: *
ZIP Code: *
E-mail Address: *  name@domain.com
Confirm E-mail Address: *
Phone Number: *  555.123.4567
I authorize this broker to include me in a pool group:*

What is a pool group?
I authorize the termination of the relationship with the previous supplier: *


Pool Group

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

 

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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