The Workers Cottage Electricity Move In Form

Electricity Move In Form

Please note that your account will be set up and billed upon this form's submission.

Do you want your connection within 2 business days?*
What date would you like your connection?

DayMonthYear
Date
Sub Date

DayMonthYear
Date
Sub Time

:HourMinutesAM/PM Option
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
Please Take A Photo Of Your Card
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
Referee Contact Details
Referee Name*

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

Fees Options
All lots at The Workers Cottage will receive the following commercial rates:

Debit Arrangements
Please choose a method of payment:
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 Jade Utilities Management Rights Pty Ltd as per the Terms and Conditions of the Jade 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
Bank Code / BSB*
Type*
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 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

Feedback
Did you know that Jade is the only building that offers prepaid and postpaid utility solutions?
Would you like to find out how prepayment would benefit you?
How was your sign up experience?
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Electricity Move In Form