Form Center

2. Account #
   Office use only
3. Account Start Date*
   Account Start Date
4. What is your account type?*

   1. Homeowner
   2. Renter
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. Landlord Name & Number
48. 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.
50. Applicant Electronic Signature*
51. Date*
    Date
53. Co-Applicant Electronic Signature
55. Rules and Regulations
    Rules and Regulations

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

57. Applicant Signature
58. Date:
    Date:
60. Co-Applicant Signature
62. 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.
    
    
Leave This Blank:


64. 1. Receive an email copy of this form.
65. Email address

    This field is not part of the form submission.

66. Submit

* indicates a required field