Power to Join

Plico Staff

First name

Last name

Number of Property Owners *

How many property owners are listed on the title deed?

Phone Number (mobile) *

Email *

Full name signer 1

Signer 2 Name

Full Legal Name

Signer 2 Email

Signer 3 Name

Full Legal Name

Signer 3 Email

Signer 4 Name

Full Legal Name

Signer 4 Email

Extra Signers

Please list the full legal names and email addresses of any further property owners listed on the property title deed.

Street Address *

City/Suburb *

State *

Postcode *

Solution Name *

Solution Name for Hubspot

Number of Systems *

Solution Details

Solution ID

Solution

PV

Solution Configuration

Property Ownership *

Property Ownership YN

Yes false

Is the property mortgaged? *

Yes No

Lender

Landlord Name

Landlord Email

Notes

Date of Birth *

Drivers Licence Number *

Drivers Licence State *

Notes

By submitting this form I (on my own behalf and on behalf of any other person named as an applicant) (together, "I", "me" or "my") give Starling Energy (Creators of Plico Energy) ("Starling Energy") consent to:

*

Proceed with Synergy and Western Power applications on my behalf, in relation to the installation of the Plico system; and

*

Starling Energy or its agent undertaking a credit check on me with the Credit Reporting Body (CRB) Experian Asia Pacific Pty Ltd and/or other equivalent CRB (in accordance with Starling Energy’s credit reporting policy, which is available below).

Link: Starling Energy’s credit reporting policy

By submitting this form I acknowledge and agree to the following:

*

The current form does not replace the need for a contract for the provision of the services contemplated, and as such this form does not give rise to a binding agreement between me and Starling Energy in relation to the provision of services to me. A services contract will be distributed electronically to the property owners and will require my signature (if both Starling Energy and I wish to proceed) before any equipment is installed.

*

If Western Power determines that my premises requires a meter upgrade to enable Starling Energy's equipment to participate in a virtual power plant (i.e. measure and record electricity flows in each direction), Starling Energy will assist me to arrange for Western Power (or its contractor) to install a new meter at my cost, before Starling Energy installs its equipment.

*

Starling Energy collects, uses, discloses and stores my personal information (including information submitted in this form) in accordance with Starling Energy's privacy policy (link below).

Link: Starling Energy's privacy policy

Where there are two or more people named as applicant on this form, the applicant submitting this form confirms that they are authorised to give the consents and make the acknowledgements on behalf of each other named applicant.

Your Details

Installation Address

Plico Solution

Property Ownership

Credit Check Information