Country Energy - LPG Replacement order form

Existing Country Energy LPG customer with an exchange cylinder can use this form to order a replacement cylinder. Customers on our top-up service can arrange a top-up by contacting us. To set up a new LPG account, please use our residential or business new customer forms..

* Required information Required information
** One field required One or other required

*Customer number:

Title (eg. Mr, Mrs):

*First name:

*Surname:

Phone:

Fax:

Email:

*Preferred method of contact:

Number of Cylinders:

*Street Address

*City / Suburb:

*Postcode:

State:

Additional delivery instructions? (dogs, hazards, etc)

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1. Account details