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Energy Connection Request

Please read or download the:

Pricing? Please refer to relevant tariff schedule.

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




1. Type of connection(s)


* Select the type of energy you want to connect. (You can select both)
Electricity
*Gas


2. Connection date


Must be a business day. Please allow at least two business days notice.
e.g. 09/07/2008 (dd/mm/yyyy)
*Gas:Due to supply and installation requirements, connection to gas may take longer than two business days. An existing Natural Gas Network in your area may also be required. One of our customer service staff will contact you to discuss your gas connection request.


3. Do you wish to connect an existing building?


Yes
No
* If No, please enter details of the location and requirements:


4. Are you an existing Country Energy customer?


Yes
No
* If Yes, please enter your customer number
If No, please enter:
Title:
* First Name:
Middle Name:
* Surname:


5. Customer type


Domestic
Rural
Business
* If Business, please enter:
* Trading name:
* ABN:


6. Sign up to countrygreen® ?


By signing up to countrygreen®, you can choose to have a percentage of your energy sourced from renewable sources from an additional $1.00 per week including GST.
Sign up to countrygreen® now?
Yes
No
Domestic or Rural Customers
Product *Price (incl. GST)AccreditationGreenPower kWh'sPlease select
foreverGREEN$6.00 extra per week100%6,470 kWh'sYes
livingGREEN$3.85 extra per week50%3,235 kWh'sYes
liteGREEN$1.85 extra per week20%1,294 kwhYes
everydayGREEN$1.00 extra per week10%647 kWh'sYes


Business Customers
Product *Price (incl. GST)AccreditationGreenPower kWh'sPlease select
countrygreen® energy - businessAdditional 1.1 cent per kWh10%Consumption basedYes
businessADVANTAGEAdditional 5.5 cent per kWh100%Consumption basedYes
By signing up to the product of your choice, the respective amount of renewable energy shown in the table above will be purchased on your behalf.


7. Proof of identity


* Date of birth:
 e.g. 26/09/86
* Driver's licence number:
 Or a password you nominate.


8. Occupant status


Tenant
Owner
* If Tenant, please enter:
* Name of owner:
* Address:
* City / Suburb:
* Phone number:


9. Address that you want to connect


Description:
Property name:
National Metering Identifier: For electricity connection only
** NMI:
Note: The NMI number for the premises will be shown on a recent bill for that premises. It uniquely identifies your premises in the national electricity market. If you do not have that information, please complete the Service address box.
And / Or
Service address: For electricity or gas connection
** Street:
** City / Suburb:
** Postcode:
State:


10. Do you have a pensioner or veteran's card?


Yes
No
If Yes, click here to access the relevant concession information.


11. Do you have a life support system at the service address?


Yes
No
* If Yes, what type is it?


12. Do you have a dog or dogs at the service address?


Yes
No
* If Yes, please enter breed(s)


13. Access to meter box


Is there any issue that the meter reader should be aware of? e.g. 1Meter box behind a fence or gate.


14. Please enter your contact details


** Home phone:
** Work phone:
** Mobile:
Email:
* Preferred method of contact:
Postal address
Same as Service Address
** Street or PO Box:
** City / Suburb:
** Postcode:
State:

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