ECOORIGIN Free Fridge Application Form

FREE Fridge Application Form

This product is delivered as a part of Victorian Energy Upgrade Program.
Eligibility Requirements

- Be a registered Drinks or Food Related business or have a genuine reason for use.

- Have an active ABN

- Be operating in a shop, factory or non-residential premise

- Show proof of business legitimacy

- Food Trucks/Vans are not eligible

- Sporting clubs/Accomodation/Schools/Function Venues ( Must show food registration or liqour licence)
Company Name *
Trading Name *
ABN *
Business Address *

Street Number

Street Name

Street Type Suburb

Post Code
Business Type *
Cafe, Restaurant, grocery, supermarket etc
Your Name *

First Name Last Name
Land Line Number
Please enter a valid phone number.
Mobile Phone Number *
Please enter a valid phone number.
Email *
example@example.com
Proof of Business Legitimacy *

As a requirement we need to qualify your business premise... Please upload one of the following showing business name and address
Cancel of
Evidence supplied

Business Card with address on it Website Screenshot with address details Utility Bill with address details Lease Agreement Liquor license / food registration Other
Have you received a free/discounted fridge under the Victorian Energy Upgrade program in last 12 months? (Failure to disclose may result in paying full amount of new supplied fridge) *

Yes No
If yes on above question, select how many fridges you have received before under the Victorian Energy Program? *
If you have received before, please describe as much as information of past fridge/fridges received under the program for us to find a fit for purpose and eligibility on new fridge. *
Please disclose without fail if received before, if not received write answer NO.
Photo of shopfront showing SIGNAGE *

This is for delivery driver to identify exact location
Cancel of
*

I have not previously received a rebate from the Victorian Energy Upgrades ( Fridge/Freezer) program. Failuring to disclose correct information may result in paying the full amount for the product supplied.
All installations are provided by Ecoorigin Pty Ltd under the Energy Saving Scheme of State Government.
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FREE Fridge Application Form