Primary Fuel Type Serviced (Select one)*:
Company Diversity Certification (If applicable):
Provider Inquiry (Check if interested in becoming an approved provider.)
Please select at least one Business Type.
Please select at least one Service.
Please select at least one County.
Please submit a current copy of your certificate of insurance with your application.
By my signature below, I represent and warrant that (i) I am duly authorized to submit this Application on behalf of the Applicant; (ii) the
information provided in this Application and any other related documents delivered to TRC and NIPSCO, is true, accurate and complete;
(iii) I have read this Application in its entirety; and (iv) I understand and accept the terms and conditions contained in this Application. I
further understand and accept that the approval or rejection of the Application is in the discretion of TRC and NIPSCO and that only upon
receipt of any Program-Specific Application Approval Notice will Applicant be a Trade Ally of TRC’s Trade Ally Network (NIPSCO).
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CLICK HERE TO DOWNLOAD THE INSURANCE REQUEST FORM
