Are you currently an Elgas customer?
Yes
No
Would you like to add your Elgas bill to your Farmlands Account?
Yes
No
Elgas Account Number:
First Name
Last Name
Shareholder Number
Phone
Email
Delivery Address
Additional Comments
If quote, advise what quote is for
By clicking submit I agree to the
Terms and Conditions.
reCAPTCHA helps prevent automated form spam.
The submit button will be disabled until you complete the CAPTCHA.