AJ Stevenson Joining Form

Todays Date

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CLOSE DATE

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What are you after?*

Electricity onlyGas onlyElectricity & Gas
IF KNOWN, please enter your Electricity ICP number
IF KNOWN, please enter your Gas ICP number

About Yourself
Please select your Property Management Company*

Account Name*
First Name*
Surname*
Birth Date*

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E-mail*
Landline Phone

Area CodePhone Number
Mobile Number
Is there a second account holder?

Yes
Second Account Holder
First Name
Surname
Birth Date

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Landline Number

Area CodePhone Number
Mobile Number

Area CodePhone Number
E-mail
Is there a third account holder?

Yes
Third Account Holder
First Name
Surname
Birth Date

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Landline Phone

Area CodePhone Number
Mobile Number

Area CodePhone Number
E-mail
Is there a fourth account holder?

Yes
Fourth Account Holder
First Name
Surname
Birth Date

DayMonthYear
Landline Phone

Area CodePhone Number
Mobile Number

Area CodePhone Number
E-mail
Is there a fifth account holder?

Yes
Fifth Account Holder
First Name
Surname
Birth Date

DayMonthYear
Landline Number

Area CodePhone Number
Mobile Number

Area CodePhone Number
E-mail

Supply Address
Time at address*

I have recently moved inI'm planning to move in soon
When did you move?

DayMonthYear
When are you moving?

DayMonthYear
Building Name
Unit / Level
Address*
Can we send mail to this address?

YesNo
Postal Details
Postal Address

Postal Address Line 1 (PO Box number or Street Number and Name)

Postal Address Line 2 (Suburb)

Postal Address Line 3 (City)Postal Region

Post Code / Zip Code

Medical Dependancy & Vulnerability
Is anyone in your property vulnerable or dependent on electricity for critical medical support?*

YesNo
Please provide details
Please Note

Supply of electricity to your property may be interrupted by incidents outside our control such as severe weather or line damage. If you are medically vulnerable and require uninterrupted supply please contact your GP, DHB or relevant medical specialist.

The Electricity Commission defines vulnerability as follows:

if for reasons of age, health or disability, the disconnection of electricity to the customer (or anyone living at the same property as the customer) presents a clear threat to the health or wellbeing of any of them; or

it is genuinely difficult for the customer (or anyone living at the same property as the customer) to pay his or her electricity bills because of severe financial instability (including because of low income), whether temporary or permanent.

The Electricity Commission defines being dependent on electricity for critical medical support as follows:

where loss of mains electricity to the customer (or anyone living at the same property as the customer) may result in loss of life or serious harm. This could include the use of mains electricity for medical or other electrical equipment needed to support the treatment regime, e.g. a microwave to heat fluids for renal dialysis.

Payment options

Switch Utilities requires payment to be made via a Dirtect Debit arrangement.
Select payment method*

Direct DebitDirect CreditChequeDebit CardCredit CardThird Party (we will contact you for further information)
Setting up a Direct Debit

Please fill in your account details below or CLICK HERE to download a hard copy.
Name on Account*
Name of Authorised Account Signatory (if different form Account Name)
Select Bank (please select)*
Bank Account Number
Please enter bank account number
Bank Postal Address
Store/Branch*

Direct Debit Terms

CONDITIONS OF THIS INSTRUCTION TO ACCEPT DIRECT DEBITS UNDER THE PAPERLESS SERVICE

1.     The Initiator (Switch Utilities Ltd):

Switch Utilities Ltd Contact details are:

Phone: 09 489 5291 | Fax: 09 489 2072

PO Box 33 1470, Takapuna, Auckland 0622

a)     Has agreed to send Notice of the net amount of each Direct Debit no later than the day the Direct Debit is initiated. This notice will be provided in writing (including by electronic means and SMS where the Customer has provided prior written consent (including by electronic means including SMS) to communicate electronically).

The notice will include the following message: ‑

"The amount of $..........., was Direct Debited to your Bank account on (initiating date)."

b)     May, upon the relationship which gave rise to this Instruction being terminated, give notice to the Bank that no further Direct Debits are to be initiated under the Instruction. Upon receipt of such notice the Bank may terminate this Instruction as to future payments by notice in writing to me/us.



2.     The Customer (you) may:

a)     At any time, terminate this Instruction as to future payments by giving notice of termination to the Bank and to the Initiator by means agreed by the customer, Bank and Initiator.

b)     Stop payment of any Direct Debit to be initiated under this Instruction by the Initiator by giving written notice to the Bank prior to the Direct Debit being paid by the Bank.

c)     Where a variation to the amount agreed between the Initiator and the customer from time to time to be Direct Debited has been made without notice being given in terms of clause 1(a) above, request the Bank to reverse or alter any such Direct Debit initiated by the Initiator by debiting the amount of the reversal or alteration of a Direct Debit back to the Initiator through the Initiator’s Bank PROVIDED such request is made not more than 120 days from the date when the Direct Debit was debited to my/our account.

d)     Request the Bank to reverse any Direct Debits initiated by the Initiator under the Instructions by debiting the amount of the Direct Debits back to the Initiator through the Initiator’s Bank where the Initiator cannot produce a copy of the Instructions and/or Confirmation to me/us that I/we are reasonably satisfied demonstrate that I/we have authorised my/our bank to accept Direct Debits from the Initiator against my/our account PROVIDED the request is made not more than 9 months from the date when the first Direct Debit was debited to my/our account by the Initiator under the Instructions.

3.     The Customer acknowledges that:

a)     This Instruction will remain in full force and effect in respect of all Direct Debits passed to my/our account in good faith notwithstanding my/our death, bankruptcy or other revocation of this Instruction until actual notice of such event is received by the Bank.

b)     In any event this Instruction is subject to any arrangement now or hereafter existing between me/us and the Bank in relation to my/our account.

c)     Any dispute as to the correctness or validity of an amount debited to my/our account shall not be the concern of the Bank except in so far as the Direct Debit has not been paid in accordance with this Instruction. Any other dispute lies between me/us and the Initiator.

d)     Where the Bank has used reasonable care and skill in acting in accordance with this Instruction, the Bank accepts no responsibility or liability in respect of:-

                                              i.    the accuracy of information about Direct Debits on Bank statements; and

                                             ii.    any variations between notices given by the Initiator and the amounts of Direct Debits.

e)     The Bank is not responsible for, or under any liability in respect of the Initiator's failure to give notice in accordance with 1(a) nor for the non-receipt or late receipt of notice by me/us for any reason whatsoever. In any such situation the dispute lies between me/us and the Initiator.

4.     The Bank may:

a)     In its absolute discretion conclusively determine the order of priority of payment by it of any monies pursuant to this or any other Instruction, cheque or draft properly signed by me/us and given to or drawn on the Bank.

b)     At any time terminate this Instruction as to future payments by notice in writing to me/us.

c)     Charge its current fees for this service in force from time‑to‑time.
I have authority to operate the account solely, have read and agree to the terms above and give my permission for Switch Utilities Ltd to attach a Direct Debit payment arrangement to my account.*

Yes

Thank you for setting up a direct debit.

A letter confirming this arrangement will be sent to your email shortly. If you do do reicieve this within the next two business days, please contact us on 09 489 5291.

CANCELLING A DIRECT DEBIT

If at any stage you would like to cancel your direct debit instructions, please contact us on 09 489 5291.

Terms

I confirm that I am over 18 and that these details are correct, to the best of my knowledge.

I accept Switch Utilities Ltd Terms and Conditions of supply and that they will assign the correct pricing plan according to my area and meter configeration.

I authorise Switch Utilities Ltd to act on my behalf to switch me to Switch Utilities Ltd as quickly as possible, including by contacting my current electricity retailer to finalise my account using my meter read (if entered).

I am authorised to organise supply of electricity and gas to this property.
I agree to the Terms*

Yes
Should be Empty:

About Yourself

Second Account Holder

Third Account Holder

Fourth Account Holder

Fifth Account Holder

Supply Address

Postal Details

Medical Dependancy & Vulnerability

Payment options

Setting up a Direct Debit

Bank Account Number

Bank Postal Address

Direct Debit Terms

Thank you for setting up a direct debit.

CANCELLING A DIRECT DEBIT

Terms