Sign up - Emergency v2 (26

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Supply Address details
What type of property is the Supply Address? *

Residential Business
What would you like to do? *

Set up for new address (moving in) Join us at current address
Enter the date you require the power to be turned on, in your name *

DD MM YY
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.
Enter the Supply Address *
Suburb *
State *

Qld NSW SA Vic
Postcode *
NMI number
We can ONLY connect your electricity. We do not currently supply gas until we can do so sustainably from renewable sources.
Account Representative details
Preferred title *
Full name *
Primary contact number *
Alternative contact number
Date of birth *

Day Month Year
Billing email *
Required for sending communications and bills
My mailing address is different to the Supply Address
Postal Address
Suburb
State

Qld NSW SA Vic WA NT ACT
Postcode
Identification type *

Drivers Licence Medicare Passport
Identification number *
Business name
Business ABN
Do you want to add a Secondary Representative?

Yes No
Preferred title
Full name
Contact number
Contact email
Required for sending communications
Date of birth

Day Month Year
Metering details
Is your electricity meter accessible for meter reading purposes? *

Yes No
Describe the access issues to your electricity meter
Is your electricity switchboard accessible? *

Yes No
Describe the access issues to your switchboard
Do you have a solar system at the Supply Address? *

No Yes
Name of solar installer
Only if you have recently installed / installing solar
Payment details
Set up Direct Debit?

Yes, with a Bank Account Yes, with a Credit Card No
Account Holder details
BSB
Account number
Credit Card details
Credit Card number
Credit Card expiry month
Credit Card expiry year
Credit Card CCV
We accept Mastercard or Visa, but not AMEX. A surcharge may apply for Credit Card payments.
Other details
Are you eligible for Government electricity supply concession / rebates?

No Yes
Concession card type?

Department of Veterans Affairs Pension Concession Card Health Care Card DVA Gold Card
Concession details
Concession card expiry

Day Month Year
To receive a concession / rebate, the Account Representative and Supply Address must be the same as on the Concession Card .
I have Life Support equipment at the Supply Address
Life Support details *
I was referred by an existing customer
Referrer details
Interested in GreenPower?

No Yes, email me more information
Do you want to receive promotional material regarding related goods and services?

Yes No
Any comments or additional notes?
Confirmation
Please enter the text as shown in the box *
Should be Empty:

Supply Address details

Account Representative details

Metering details

Payment details

Other details

Confirmation