Country Energy - Commercial Electricity Contract Quotation

Switching to Country Energy may save your business money. Complete the form below and one of our account managers will be in touch with you as soon as possible. This form will only take a few minutes to complete – but you will need a copy of your latest account so you can provide your consumption details.

* Required fields
** One field required One or other required

* Business name:

* ABN:

Title:

* First Name:

* Last Name:

Phone:

Fax:

Email:

Preferred method of contact:

* Street:

* City / Suburb:

* Postcode:

State:

** National Metering Identifier (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.

Service Address:

** Street:

** City / Suburb:

** Postcode:

State:

12 months
18 months
24 months
36 months

e.g. 16/08/2008

Existing
New

To provide you with a quote we need to know your consumption details and how you currently purchase your electricity. This information can be found on the back of your account.

** Please enter the option that applies to you:

Total (kWh)	Tariff Code
Off Peak 1 (kWh)	Tariff Code
Off Peak 2 (kWh)	Tariff Code

Number of days for this account?
Name of Tariff (e.g. Business - Urban)

or

Time of use tariffs:

Peak (kWh)

Shoulder (kWh)

Off Peak (kWh)

Demand component in kW or kVA

Number of days for this account?

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.

Product *	Price (incl. GST)	Accreditation	GreenPower kWh's	Please select
countrygreen® energy - business 10%	Additional 1.43 cent per kWh	10%	Consumption based	Yes
countrygreen® energy - business 100%	Additional 7.15 cent per kWh	100%	Consumption based	Yes

e.g. I require a quote for green energy or would like information on energy efficiency.

Concerned about Privacy? Please be aware Country Energy will only use this information for the purposes outlined on this page. For more information on Privacy, please refer to our Privacy Policy.

Business details

* Business name:

* ABN:

Contact details

Title:

* First Name:

* Last Name:

Phone:

Fax:

Email:

Preferred method of contact:

Postal address

* Street:

* City / Suburb:

* Postcode:

State:

NMI or Service address

** National Metering Identifier (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.

Service Address:

** Street:

** City / Suburb:

** Postcode:

State:

Please select your preferred contract term

Please indicate your preferred contract start date:

e.g. 16/08/2008

What type of connection is this?

Consumption

** Please enter the option that applies to you:

or

Time of use tariffs:

Who is your current electricity retailer?

Please tick if you are interested in any of our countrygreen® options, listed below:

Any comments/questions?

e.g. I require a quote for green energy or would like information on energy efficiency.