Safe Disconnect LV Standard

Name*

First NameLast Name
Phone Number*
Phone Number
Email*
example@example.com
If you prefer us to contact a tradesperson or someone else about these arrangements, please enter their details here:
Tradespersons Name

First NameLast Name
Phone Number
Phone Number
Which disconnection service would you like?*

Business hours (8am - 4pm Mon-Fri excl. public holidays, no cost incurred)After hours (after 4pm Mon-Fri weekends and public holidays, an extra charge will be due for after hours)
What address(es) do you need disconnected?*

Street Address

Street Address Line 2

CitySuburb

Postal / Zip Code
What kind of work are you planning?*

Electrical workBuilding MaintenanceNew Building/Structure (All structures must meet the requirements of ECP34. Depending on the proximity of the new structure to the lines, further consultation may be necessary please call 0800 100 202) https://www.countiesenergy.co.nz/forms/new-connection-for-residentialTree Trimming (If application is approved, please Call control room before and after work)Other
Feel free to make any other comments about your needs here:
Date for disconnection (at least 3 business days from today)*

DayMonthYear
Date
Date for reconnection (if different to disconnection)

MonthDayYear
Date
Start time*

Hour Minutes

AM/PM Option
End time*

Hour Minutes

AM/PM Option
Should be Empty: