Gas Fitter Request for LPG

Name

First NameLast Name

Email

example@example.com

Mobile

Please enter a valid phone number.Format: (000) 000-0000.

Office Phone

OptionalFormat: (000) 000-0000.

Type of work

Account Number

Installation type

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Property type

Is it a strata-title or does it share common ground?

Is it a new (under-construction) or existing property?

Builder's Name

Please specify

Site contact name for Installation

Site contact number

Please enter a valid phone number.Format: (000) 000-0000.

Is the distance from the meter box to the property's front boundary more than 6 meters?

6 meters or under = standard connection fee, over 6 meters will require a quote

Standard connection fee is $825 (inc GST)

We will be in contact with you to provide a new connection quote

Do you authorise Supagas to bill the standard connection fee of $825 (inc GST)?

Meter Location

Pressure

Date connection required

Is a meter box installed?

Is there a Type B appliance?

Gasfitter's Name

First NameLast Name

Gasfitter's license number

Gasfitter's contact number

Please enter a valid phone number.Format: (000) 000-0000.

Gasfitter's email

example@example.com