Form Center

2. Account #
   Office use only
3. Account Start Date*
   Account Start Date
4. Do you own the home

   1. Yes
   2. No
6. Account Holder Name*
8. Date of Birth*
   Date of Birth
10. Primary Phone Number*
    format xxx-xxx-xxxx
11. Secondary Phone Number
    format xxx-xxx-xxxx
13. Email*
15. Would you like to add a Co-Applicant*

    1. Yes
    2. No
17. Co-Applicant Name*
19. Co-Applicant Date of Birth*
    Co-Applicant Date of Birth
21. Co-Applicant Email
23. Service Address*
25. City*
26. Zip Code*
27. Name of Subdivision*
    Put "no" if not in one.
29. Mailing address different

    1. Yes
    2. No
31. Mailing Address (If different from Service Address)
33. City
34. State
35. Zip Code
37. How would you like your statements delivered?*

    1. Postal Mail
    2. Email
38. Email
40. Delinquent Text Notification*

    1. Yes
    2. No
41. Phone Number
    format xxx-xxx-xxxx
43. Have you had service with FING before?*

    1. Yes
    2. No
44. What was your previous address
46. Electronic Signature Agreement*

    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.
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
48. Applicant Electronic Signature*
49. Date*
    Date
51. Co-Applicant Electronic Signature
53. Rules and Regulations
    Rules and Regulations

    I have read and agree to the rules and regulations. Print for your records

55. Applicant Signature*
56. Date:*
    Date:
58. Co-Applicant Signature
60. Thank You
    After submitting, please wait about 30 minutes to call the office at 864-862-0042 to complete your application.
    The applicant agrees to pay a fifty dollar ($50.00) non-refundable enrollment service fee and a refundable security deposit which is determined by a credit check payable upon establishing an account.
    This fee obligates the applicant to observe all rules and regulations that are now and may hereafter be prescribed by the said city relative to gas service, including the time, method and manner of installing and maintaining equipment, payment of bills, and discontinuance of service, etc.
    
    We will need you to email a copy of your ID to FING@fountaininn.org and when you call we will need to get your SSN to determine if you have a deposit.
62. Please read the following carefully, initial each paragraph

64. The customer is responsible for identifying all underground objects that might be damaged in the process of installing the new service line. Underground objects are, but not limited to septic tanks, drain fields, sewer lines, water lines, irrigation lines and electrical/cable lines not owned by a company.

65. Initial*

67. The customer will physically mark any underground objects within (+) or (-) 30 inches, using paint, flags or stakes. If underground objects are not adequately marked, the customer will assume full responsibility for any damage to underground objects. In areas with trees, Fountain Inn Natural Gas (FING) will make every attempt to protect them; however, FING will not be held responsible for root damage and/or the overall health of any tree.

68. Initial*

70. Once the job is completed, FING will make every attempt to restore the yard to its original level, raking the topsoil, adding grass seed and straw in the affected areas. If you have any concerns regarding your yard, grass, plants, etc., please notify us immediately before starting the work so we can discuss options with you.

71. Initial*
73. Equipment Installed

    1. Gas Furnance
    2. Gas Logs
    3. Gas Water Heater
    4. Gas Tankless Water Heater
    5. Gas Range/Cook Stove
    6. Pool Heater
    7. Grill
    8. Generator
    9. Gas Assisted Heat Pump
    10. Gas Lights
74. If installing more than 1
75. Other Equipment
77. Length of Service Line
    What is the approximate location from edge of street to desired gas meter location?
78. TOTAL BTU LOAD PER HOUR:
    (Contractor/Installer will have this information)
79. DELIVERY PRESSURE REQUIRED:

    1. 7" meter
    2. 2lb meter
    3. 5lb meter

    Meter Size
81. Electronic Signature*
82. Date*
    Date
Leave This Blank:


84. 1. Receive an email copy of this form.
85. Email address

    This field is not part of the form submission.

86. Submit

* indicates a required field