{"id":1893,"date":"2026-03-06T16:12:38","date_gmt":"2026-03-06T23:12:38","guid":{"rendered":"https:\/\/crossroadsgas.com\/wordpress\/?page_id=1893"},"modified":"2026-03-11T09:57:01","modified_gmt":"2026-03-11T15:57:01","slug":"forms","status":"publish","type":"page","link":"https:\/\/crossroadsgas.com\/wordpress\/?page_id=1893","title":{"rendered":"Subscribe"},"content":{"rendered":"<div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-f6d9ccd1-8697-4e9c-8a3e-4d64beb873ea wpforms-render-modern\" id=\"wpforms-1846\"><form id=\"wpforms-form-1846\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"1846\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/wordpress\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F1893\" data-token=\"7ae72baeb4118fb632eefec58f61db73\" data-token-time=\"1777507198\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-1846-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-1846-field_1\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1846-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" aria-errormessage=\"wpforms-1846-field_1-error\" required><\/div>\t\t<div id=\"wpforms-1846-field_4-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"4\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-1846-field_4\" >Gas gas This<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-1846-field_4\" class=\"wpforms-field-medium\" name=\"wpforms[fields][4]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-1846-field_2-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-1846-field_2\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1846-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" spellcheck=\"false\" aria-errormessage=\"wpforms-1846-field_2-error\" required><\/div><div id=\"wpforms-1846-field_8-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-1846-field_8\">Phone number <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1846-field_8\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][8]\" aria-errormessage=\"wpforms-1846-field_8-error\" required><\/div><div id=\"wpforms-1846-field_6-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-1846-field_6\">Gas account number <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1846-field_6\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][6]\" aria-errormessage=\"wpforms-1846-field_6-error\" aria-describedby=\"wpforms-1846-field_6-description\" required><div id=\"wpforms-1846-field_6-description\" class=\"wpforms-field-description\">If you don&#8217;t have an account number yet, please write New in the field above<\/div><\/div><div id=\"wpforms-1846-field_9-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"9\"><fieldset><legend class=\"wpforms-field-label\">Please sign me up for: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1846-field_9\" class=\"wpforms-field-required\"><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-1846-field_9_3\" name=\"wpforms[fields][9][]\" value=\"Customer Portal\" aria-errormessage=\"wpforms-1846-field_9_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1846-field_9_3\">Customer Portal<\/label><\/li><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1846-field_9_1\" name=\"wpforms[fields][9][]\" value=\"Emailed bills\" aria-errormessage=\"wpforms-1846-field_9_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1846-field_9_1\">Emailed bills<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-1846-field_9_4\" name=\"wpforms[fields][9][]\" value=\"Equalized Payment Plan (only in the spring time)\" aria-errormessage=\"wpforms-1846-field_9_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1846-field_9_4\">Equalized Payment Plan (only in the spring time)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1846-field_9_2\" name=\"wpforms[fields][9][]\" value=\"Pre-Authorized Debit (fill out below)\" aria-errormessage=\"wpforms-1846-field_9_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1846-field_9_2\">Pre-Authorized Debit (fill out below)<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1846-field_10-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-1846-field_10\">Transit Number (5 digits)<\/label><input type=\"text\" id=\"wpforms-1846-field_10\" class=\"wpforms-field-small\" name=\"wpforms[fields][10]\" aria-errormessage=\"wpforms-1846-field_10-error\" ><\/div><div id=\"wpforms-1846-field_11-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-1846-field_11\">Institution Number (3 digits)<\/label><input type=\"text\" id=\"wpforms-1846-field_11\" class=\"wpforms-field-small\" name=\"wpforms[fields][11]\" aria-errormessage=\"wpforms-1846-field_11-error\" ><\/div><div id=\"wpforms-1846-field_12-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-1846-field_12\">Bank Account Number<\/label><input type=\"text\" id=\"wpforms-1846-field_12\" class=\"wpforms-field-medium\" name=\"wpforms[fields][12]\" aria-errormessage=\"wpforms-1846-field_12-error\" ><\/div><div id=\"wpforms-1846-field_19-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"19\"><fieldset><legend class=\"wpforms-field-label\">This gas service is for:*<\/legend><ul id=\"wpforms-1846-field_19\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1846-field_19_1\" name=\"wpforms[fields][19]\" value=\"Personal use\" aria-errormessage=\"wpforms-1846-field_19_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1846-field_19_1\">Personal use<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1846-field_19_2\" name=\"wpforms[fields][19]\" value=\"Business (commercial activities)\" aria-errormessage=\"wpforms-1846-field_19_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1846-field_19_2\">Business (commercial activities)<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1846-field_17-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"17\"><fieldset><legend class=\"wpforms-field-label\">Pre-Authorized Debit (PAD) Agreement*<\/legend><ul id=\"wpforms-1846-field_17\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1846-field_17_1\" name=\"wpforms[fields][17]\" value=\"I have read and agree to the PAD Agreement*\" aria-errormessage=\"wpforms-1846-field_17_1-error\" aria-describedby=\"wpforms-1846-field_17-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1846-field_17_1\">I have read and agree to the PAD Agreement*<\/label><\/li><\/ul><div id=\"wpforms-1846-field_17-description\" class=\"wpforms-field-description\">You, the Payor, authorize Crossroads Gas Co-op Ltd. to debit the bank account identified above for the exact amount of the accounts outstanding balance. Date of the withdrawal will be the 22nd of each month, or the next business day. Crossroads needs 4 business days prior to the 22nd of the month to set up, change or cancel your pre-authorized debit. Crossroads will provide at least 10 days notice of the amount of each debit. This authority is to remain in effect until you notify Crossroads of its termination. You have certain recourse rights if any debit does not comply with this agreement. For example, you have the right to receive reimbursement for any debit that is not authorized or is not consistent with the PAD Agreement. For more information on your rights to cancel a PAD Agreement or your recourse rights, contact your financial institution or visit www.payments.ca. Crossroads Gas Co-op Ltd. 36060 Range Road 282 Red Deer County, AB T4G 0G6 403-227-4861.<\/div><\/fieldset><\/div><div id=\"wpforms-1846-field_3-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-1846-field_3\">Comment or Message<\/label><textarea id=\"wpforms-1846-field_3\" class=\"wpforms-field-medium\" name=\"wpforms[fields][3]\" aria-errormessage=\"wpforms-1846-field_3-error\" aria-describedby=\"wpforms-1846-field_3-description\" ><\/textarea><div id=\"wpforms-1846-field_3-description\" class=\"wpforms-field-description\">Thank you for filling out this form. We will contact you if we need more information.<\/div><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-1846-field_4-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-1846-field_4-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-1846-field_4-container label { counter-increment: none; }' ) );\n\t\t\t\t\tdocument.head.appendChild( style );\n\t\t\t\t\tdocument.currentScript?.remove();\n\t\t\t\t} )();\n\t\t\t<\/script><\/div><!-- .wpforms-field-container --><div class=\"wpforms-recaptcha-container wpforms-is-recaptcha wpforms-is-recaptcha-type-v2\" ><div class=\"g-recaptcha\" data-sitekey=\"6LcjmpYsAAAAAPpll3KARXpH-qXyQTXlclKLM7Dd\"><\/div><input type=\"text\" name=\"g-recaptcha-hidden\" class=\"wpforms-recaptcha-hidden\" style=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\" data-rule-recaptcha=\"1\"><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"1846\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/crossroadsgas.com\/wordpress\/index.php?rest_route=\/wp\/v2\/pages\/1893\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-1846\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/crossroadsgas.com\/wordpress\/wp-content\/plugins\/wpforms-lite\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1893","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/crossroadsgas.com\/wordpress\/index.php?rest_route=\/wp\/v2\/pages\/1893","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/crossroadsgas.com\/wordpress\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/crossroadsgas.com\/wordpress\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/crossroadsgas.com\/wordpress\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/crossroadsgas.com\/wordpress\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1893"}],"version-history":[{"count":0,"href":"https:\/\/crossroadsgas.com\/wordpress\/index.php?rest_route=\/wp\/v2\/pages\/1893\/revisions"}],"wp:attachment":[{"href":"https:\/\/crossroadsgas.com\/wordpress\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1893"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}