Form Center

New Customer Application

2. Account #

   Office use only

3. Account Start Date*
   Account Start Date

4. What is your account type?*

   1. Homeowner
   2. Renter

6. Proof of Ownership

   Alternatively you may email to fing@fountaininn.org

7. Copy of Rental Agreement

   Alternatively you may email to fing@fountaininn.org

9. Account Holder Name*

11. SSN

    format xxx-xx-xxxx
    or call to give it to us

12. Date of Birth*
    Date of Birth

13. Drivers License*

    State and #

14. Copy of License

    or email to FING@fountaininn.org

16. Primary Phone Number*

    format xxx-xxx-xxxx

17. Secondary Phone Number

    format xxx-xxx-xxxx

19. Email*

21. Would you like to add a Co-Applicant*

    1. Yes
    2. No

23. Co-Applicant Name*

25. Co-Applicant SSN

    format xxx-xx-xxxx
    or call to give it to us

26. Co-Applicant Date of Birth*
    Co-Applicant Date of Birth

27. Drivers License #*

    State and #

28. Copy of License

    or email to FING@fountaininn.org

30. Co-Applicant Email

32. Service Address*

34. City*

35. Zip Code*

36. Name of Subdivision*

    Put "no" if not in one.

38. Mailing address different

    1. Yes
    2. No

40. Mailing Address (If different from Service Address)

42. City

43. State

44. Zip Code

46. How would you like your statements delivered?*

    1. Postal Mail
    2. Email

47. Email

49. Delinquent Text Notification*

    1. Yes
    2. No

50. Phone Number

    format xxx-xxx-xxxx

52. Have you had service with FING before?*

    1. Yes
    2. No

53. What was your previous address

55. 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.
57. Applicant Electronic Signature*

58. Date*
    Date

60. Co-Applicant Electronic Signature

62. Rules and Regulations
    Rules and Regulations

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

64. Applicant Signature*

65. Date:*
    Date:

67. Co-Applicant Signature

69. Thank You
    After submitting, please wait about 30 minutes to call the office at 864-862-0042 to complete your application.<BR> 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.<BR>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.<BR><BR>

    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:


71. 1. Receive an email copy of this form.
72. Email address

    This field is not part of the form submission.

73. Submit

* indicates a required field