Please enter all data fields below to complete your access request to BGE's Midstream Online Intake Tool (OIT). Once your participation is verified with your affiliated Distributor(s), BGE's Midstream program team will provide you with your unique access credentials.

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* 1. Company Name

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* 2. Please select your affiliate Distributor(s) for participation verification

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* 3. Select Midstream Product Type(s) Offered

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* 4. Enter Active MD License Detail, as applicable
(Industry licensing and insurance is required for participation under program Distributors to offer BGE midstream incentives)

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* 5. Email Address to be used for OIT Access

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* 6. Company Contact Name

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* 7. Website

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* 8. Phone Number

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* 9. Street Address

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* 10. City

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* 11. State

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* 12. ZIP Code

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