Energy Unite Integration Services Natural Gas Connection Form

Gas Connection Application

Please complete a separate form for each property services is required.
SA Citizen ResidentForeign National
PLEASE NOTE:

This for is specifically related to the connection to the live gas network as well as installation of gas metering equipment as per supplier requirement.

If the property has an exisitng gas meter and you need to register your account kindly complete the following form: Customer Registration Gas Utilities
OwnerPurchaserContractorOther
Name & Surname*

NameSurname
Primary Email*
example@example.com
Cell Number Primary*

Country CodeArea CodePhone Number
If your are the contractor please capture the tenant contact information in the below alternative detail fields
Alternative Contact Person

NameSurname
Alternative Email
example@example.com
Alternative Cell Number

Country CodeArea CodePhone Number
Building Contractor Name
Building Contractor Contact

NameSurname
Building Contractor Contact No

Country CodeArea CodePhone Number
Site Contact

NameSurname
Site Contact No

Country CodeArea CodePhone Number
Passport / ID No.*
Copy of ID/Passport*

Browse Files
(Please attach copy of passport/ID) Cancelof
Single StandMulti DwellingSectional TitleVacant StandOther
Address where service is required*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Billing address ( if different from Service address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Proof of address*

Browse Files
(please attach proof of address, not older than 3 months) Cancelof
Earliest Installation Date*

YearMonthDay
Date
TERMS AND CONDITIONS:

The gas installation team will make contact with your gas installer / building contractor to receive the Certificate of Compliance ( CoC) before they are allowed to commission the gas meter installation with live gas to the house.

A minimum of 2 weeks are required before meter installation commences barring any unforseen or outstanding work to be completed related to the gas installation in the house.
Additional Comments
Verify Primary E-mail Address*
Should be Empty:

Gas Connection Application