INNOVO Customer Electricity Move Form

To complete this connection form you will require the following:
5 Minutes of Your TimeIdentification (Drivers Licence/Passport or Equivalent)Referee DetailsMobile Phone NumberEmail AddressBank Details (credit card)Concession Cards (only if applying for a rebate)Real Estate Agent's Details ( If renting )

I.D
Personal Identification Type*
Authentication Number*
Date Of Birth Day/Month/Year*
xx/xx/xxxx
Upload a File
Please Take Photo Of Your ID (If screen is black press the turn camera around button top right corner) Cancelof

Concessions and Life Support

Please select if you hold any of the following cards:
Pensioner Concession Card issued by CentrelinkDepartment of Veterans' Affairs Gold CardA current Queensland Seniors CardA current Commonwealth Health Care Card issued by CentrelinkAsylum Seeker Status ( Immicard details required)
Please Enter Card Number
Upload a File
Please take a photograph of your ID (if the screen is black press the turn camera around button in the top right corner) Cancelof
Do you or anyone who will be living with you at this premises require life support equipment?
Leasing Agent Contact
Company Name*
Leasing Agent's Name*

PrefixFirst NameMiddle NameLast Name
Leasing Agents Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Referee Contact Details
Referee Name*

PrefixFirst NameMiddle NameLast Name
Mobile Number*
E-mail*
Relationship*

Rates & Fees
The rates to be charged on your bill will be what has been agreed with Innovo Energy and its subsequent agreements.

Debit Arrangements
I authorise and request the debit user detailed below to debit payments from my nominated account, as specified below, at intervals and amounts as directed by Australian Utilities Management Rights Pty Ltd as per the Terms and Conditions of the Australian Utilities Management Rights Pty Ltd agreement and subsequent agreements.

Fees / Charges

One Time Setup Fee $0.00

Bank Account $0.60

Optional SMS Reminder $0.00

Visa/Mastercard 1.4% (min $0.60)

Amex/Diners 3.8% (min $0.60)

Failed Payer Dishonour Fee $21.90
Payment Method
Please choose a method of payment:
Type*
Bank Code / BSB*
Card Number*
First 4 digits
Card Number*
The following digits
Expiry Date mm/yyyy*
Name On Account*
Account Number*
Name On Account*
Payments will appear on your statement as AUR UTILITIES
I / We authorise Ezidebit Pty Ltd ACN 096 902 813 (User ID No 165969) to debit my/our account at the Financial Institution identified above through the Bulk Electronic Clearing System (BECS) in accordance with the Debit Arrangement stated above and this Direct Debit Request and as per the Ezidebit DDR Service Agreement (Ver 1.11) provided. Ezidebit reserves the right to change their fees from time to time.
Terms & Conditions
I Agree With The Above Terms & Conditions

Account Type