Please send your check or money order to:

Columbia Gas
Attn: Gift Certificate Dept.
PO Box 2318
Columbus, Ohio 43216

Your payment will be applied to the account of (required fields are bold):

RECIPIENT INFORMATION
First Name
 Last Name
Street Address
City
 State
 ZIP
Account Number

PURCHASER INFORMATION
First Name
 Last Name
Street Address
City
 State
 ZIP
Account Number

A Gift From
      Date

Send certificate to recipient address
Send certificate to purchaser