Existing Supply Alteration

Site Details
Please select what request requirement you are after*

High-Level Assessment - Financial Estimate for budgetary purposesDesign and Quote - Contract Agreement (3 months validity) and Design
ICP Number (located on your electricity bill)
Address

Street Address

Street Address Line 2

CitySuburb

Postal / Zip Code
Requester Details
Name of the person completing this form*
Company name
Contact phone*
Email*
example@example.com
Legal Owner
Legal name(s) of property owner(s)*
Contact phone*
Email address*
example@example.com
Postal address*
Quote payer

In this section, the billing details of the person(s) or entity responsible for paying the quote or capital contribution should be provided here. If the details are already provided above please select this from the dropdown list below:
If the quote payer is one of the above, please select:
Full legal name
Contact phone
Email
example@example.com
Billing address*
Reason for this request
Reason for request*

Asset relocationAsset removalUpgradeDowngradeConversion from overhead to underground service
Description of requirements*
Asset Details
Please describe the location of asset*
Asset type*

PoleTransformerPillar or link boxUnsure
Asset ID (this is the unique number on the asset)
Communication

Communication is important to us. To ensure that Counties Energy keeps the right people informed throughout the design process, please complete the following section:
If a designer needs further information, who should we call?

RequesterOwnerQuote payer
Do you require a letter of compliance when the network connection point is available?

YesNo
Additional Information

Please provide any futher information regarding your request, for example for capacity changes, what would you like to increase or decrease to? Reason for an asset removal/relocation. etc.
Additional information
Should be Empty:

Site Details

Requester Details

Legal Owner

Quote payer

Reason for this request

Asset Details

Communication

Additional Information