Sign up - Emergency v2 (15_12

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Set up Residential or Business Account?*

ResidentialBusiness

What would you like to do?*

Set up for new address (moving in)Join us at current address

Date you require power to be turned on, in your name*

DDMMYY

You have requested a same day power turn on, please call us on 1300 838 009 ASAP after you have completed your sign up. Please note, same day power turn on requests can incur additional charges.

You have requested a power turn on for tomorrow, please call us on 1300 838 009 ASAP after you have completed your sign up.

Supply Address*

Suburb*

Postcode*

State*

QldNSWSAVic

Do you know your NMI?

10-11 digits from your electricity bill

Preferred title*

Full name*

First nameLast name

Primary contact number*

Alternative contact number

Date of birth*

DayMonthYear

Email*

Required for sending communications and bills

Is your mailing address the same as the supply address?

YesNo

Postal Address

Suburb

Postcode

State

Identification type*

Drivers LicenceMedicarePassport

Identification number*

Business name

Business ABN

Do you want to add a Secondary Representative?

YesNo

Preferred title of Secondary Representative

Full name of Secondary Representative

First nameLast name

Contact number of Secondary Representative

Contact email

Email address of Secondary Representative

Date of birth of Secondary Representative

DayMonthYear

Is your electricity meter accessible for meter reading purposes?*

YesNo

Describe the access issues to your electricity meter

Is your electricity switchboard accessible?*

YesNo

Describe the access issues to your switchboard

Do you have a solar system at the Supply Address?*

NoYes

Name of solar installer

Only if you have recently installed / installing solar

Is there Life Support equipment at the supply address?

NoYes, I have Life Support equipment at the Supply Address

Set up Direct Debit?

Yes, with a Bank AccountYes, with a Credit CardNo

Account Holder details

BSB

Account number

We accept Mastercard, Visa and AMEX. A surcharge may apply for Credit Card payments.

We'll send you a link to set up credit card payment method in the next coming days.

You can take out the hassles of payments by setting up Direct Debit auto payment of your bill on the due date with your bank account or credit card.

If you'd prefer to set up later, just give us a call to set up over the phone.

Are you eligible for Government electricity supply concession / rebates?

NoYes

Concession card type?

Department of Veterans AffairsPension Concession CardHealth Care CardDVA Gold Card

Concession details

Concession card expiry

DayMonthYear

To receive a concession / rebate, the Account Representative and Supply Address must be the same as on the Concession Card.

Life Support details*

Were you referred by an existing customer?

Yes

Referrer details

Interested in GreenPower?

NoYes, email me more information

Any comments or additional notes?

Please enter the text as shown in the box*

Diamond Energy Online Application