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800 Sergas
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Gas Subscription Form
Just choose your subscription type and fill out the form — it’s quick and simple.
New Gas Subscription
Existing Subscription
System No.
Restaurant Name
Company Name or Restaurant
Authorized Signature Name
Representative Name
Shop Location
Plot NO.
Unit No.
Company Address
City
Dubai
RAK
Ajman
Fuj
PO. BOX
E-mail
Telephone
Mobile No.
Fax
Mobile No. 2
Choose GasMeter Type
G4
G6
G10
G16
G20
Refundable Gas Deposite
Note: One of our SERGAS representative will reach out to you for more information
Key account representative e-mail
Date Of Subscription
Additional Notes
(Optional)
I agree to the
Terms & Conditions.
Submit
