Business Hardship Application

During the Covid-19 crisis LPE are prepared to assess your financial hardship situation and provide help. By completing this application form you will allow us to assess your situation and determine if you are eligible for acceptance into our hardship program.

If you need assistance completing this form or would like to speak to someone you can call us on 1800 040 168. We are available from 8:30am to 5:30pm Monday to Friday. You can also read more about our Customer Hardship Program here.

Account Name*

LPE Account Number*

Name

First NameLast Name

Email*

example@example.com

Mobile Number*

Select the primary reason why you're in financial hardship:

Other

Please confirm if your business has been closed:

Is the business consuming electricity?

Have you sought financial assistance from the government?

How much income is the business earning per fortnight?

Based on the above what are your business out goings?

How much are you able to pay towards your electricity bill? *

How often you can pay this amount *

WeeklyFortnightlyMonthly

When can you commence making payments? *

Date

How will you make the payments? *

Direct DebitBPAY

Provide any other information you would like us to take into consideration when assessing your financial hardship application:

By listing your name below, you declare that the information provided is true and accurate at the time of completion. You also acknowledge that the information provided will be used and stored in accordance with the Australian Privacy Act 2009.

Signature

Name

First NameLast Name

Date

LPE have a Complaints Policy and welcome the opportunity to resolve any disputes and complaints. Please call us on 1800 040 168 or email complaints@localityenergy.com.au.

If we are unable to resolve your dispute or complaint you can contact the Energy and Water Ombudsman Queensland EWOQ online https://www.ewoq.com.au/ or free call 1800 662 837 or Energy and Water Ombudsman NSW EWON https://www.ewon.com.au/ or free call 1800 246 545.

Business Hardship Application

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