Gas Transport Customer Agent/Broker Authorization

The agent/broker listed below is authorized to make nominations with Ameren Missouri on behalf of Customer for the account(s) listed below.
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
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.
Customer shall notify, in writing, Ameren Missouri in the event Customer terminates an existing relationship with the agent/broker.

Questions: ueendusertransportation@ameren.com

I have read and agree to the above.

*Required Info

Customer Information

Company Name*

First Name*

Last Name*

Title*

Email Address*

Confirm Email Address*

Account Number*

Second Account Number

Third Account Number

Fourth Account Number

Fifth Account Number

Agent/Broker Information

Company Name*

First Name*

Last Name*

Address*

City*

State*

Zip Code*

Email Address*

Confirm Email Address*

Phone Number*

I authorize this broker to include me in a pool group.*

Yes

I authorize the termination of the relationship with the previous supplier.*

Yes

I affirm that I am the person who prepared this form, or that I have prepared and submitted this form as the duly authorized executor, guardian, authorized officer, or agent of such named person, and that I acknowledge that I have read and understood all of the questions in this application and that all of the information submitted in this application is true and correct to the best of my knowledge, and that all responses to the questions are full and complete, omitting no material information.

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Gas Transport Customer Agent/Broker Authorization

Customer Information

Agent/Broker Information