Community Connection Center
Assistance Request Form

Welcome!

The Nicor Gas Community Connection Center is a free resource that provides information about bill assistance, free energy assessments, housing, food and other resources available for our customers. Please fill out this form completely and we will contact you to discuss how we can help.

We will contact you within 2 business days. If you need further assistance, you can also reach our team at cccinfo@nicorgas.com.

First Name

Last Name

Street Address

City

ZIP Code

Phone Number

Email Address

Referral Source

How did you learn about the Community Connection Center?

Hardship Type

Are you a Veteran?

Are you a Senior Citizen?(65+yrs)

Assistance Needed

Please select all that apply

If Other, Please Specify

Preferred Language

Preferred language for return call

Preferred Contact Type

Best Time to be Contacted

People in Household

This includes all people living in the household, whether or not they are related

Send me a copy of my responses

Report Abuse

Community Connection Center Assistance Request Form

Welcome!

Community Connection Center
Assistance Request Form