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Builder Application
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This form has been modified since it was saved. Please review all fields before submitting.
Account #
office use only
Route #
office use only
Name of Builder
*
Service Address
*
City
State
Zip Code
County:
Lot #
Subdivision
Billing Address:
City
State
Zip Code
Ebill Authorization:
*
Yes
No
Email for Ebill:
Contact Name:
*
Business Phone Number:
*
Contact Email Address
*
Phone Number
*
Onsite Contact Person
*
Phone Number
*
Billing Contact Person
Phone Number
Natural Gas Equipment being installed:
*
Heat
Tank Water Heater
Tankless Water Heater
Range
Logs
Grill
Dryer
Pool Heater
Generator
Heat Pump
Other ( Please Indicate)
Other
Please indicate the number of each type of equipment if more than 1.
Approximate Distance from street to meter location (measured in feet)
TOTAL BTU LOAD (cubic ft/hr) _________
DELIVERY PRESSURE NEEDED:
7" meter set
2lb meter set
5lb meter set
The Department of Transportation (DOT), under Title 49 Part 192.381, enacted new standards for residential gas service line installation to include and Excess Flow Valve on each new residence at services operating at pressures over 10 PSI. The objective of the Excess Flow Valve, also known as the EFV, is to reduce gas flow at such times the service line is damaged and the accidental release of natural gas is imminent.
I certify that all of the above information is complete and accurate. I further understand that providing false information may result in denial or termination of natural gas service. I hereby give my permission to examine my past payment history if deemed necessary by Fountain Inn Natural Gas System.
Applicant Signature:
Date
Date
Rules and Regulations
Rules and Regulations
I have read and agree to the R/R
Customer Signature:
*
Date
*
Date
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