Enter Your Details

indicates which information you must provide

Account Holder's Details

Title

First name

Last name

Mobile phone no.

Email address

Date of birth

(dd/mm/yyyy)

Home Address

Please tell us the address at which your electricity and/or gas is to be supplied:

Street no.

Street name

Street type

Suburb

State

Postcode

Electricity Meter Details

Which meter configuration do you have?

Unsure      Single      Peak and Off-Peak (dedicated electric hot water)      Peak and Off Peak (standard)

Move-in Date

Do you currently reside at this property or are you moving in?    I live there      I am moving in

As you are moving in to the above address, please enter below the date on which you wish to have the electricity/gas supply connected.

You must provide at least 3 business days' notice prior to your move-in date or you risk not having your supply connected in time.

Please note that suppliers can only arrange connections on weekdays (Mon–Fri), excluding public holidays.

You will need to contact your current supplier(s) to arrange disconnection at the home you are leaving.

Move-in date

(dd/mm/yyyy)

Please ensure that there is access to your meter at all times on the proposed day of connection.

Billing Details

Would you like to receieve your electricity bills by email instead of being posted to you?   Yes      No

Would you like your bills sent to a different address?   Yes      No

PO Box

Unit number

Street number

Street name

Street type -- select ------- Road Street Alleyway Arcade Avenue Block Boulevard Bridge Broadway Bypass Causeway Central Centre Centreway Chase Circle Circuit Close Concourse Corner Court Courtyard Cove Crescent Crest Cross Crossing Crossroad Crossway Cul-De-Sac Deviation Dip Distributor Domain Drive Driveway East Edge Elbow End Entrance Esplanade Estate Expressway Extension Fairway Fire Track Firetrail Flat Foreshore Formation Freeway Front Frontage Gap Garden Gardens Gate Glen Grange Green Gully Grove Heights Highground Highway Hill Interchange Intersection Junction Key Lane Laneway Link Little Lookout Loop Lower Mews Motorway Mount North North East North West Outlook Parade Park Parklands Parkway Pathway Piazza Place Plateau Plaza Pocket Point Port Promenade Quad Quadrangle Quadrant Quay Quays Ramble Range Reach Reserve Retreat Ridge Ridgeway Right of Way Rise Rising River Riverway Riviera Roadside Ronde Rosebowl Rotary Round Route Run Service Way Sliding Slope Sound South South East South West Square State Highway Strand Strip Subway Terrace Throughway Tollway Track Trail Trailer Triangle Trunkway Turn Underpass Upper Vale Valley Vidauct View Villas Vista Walk Walkway Water Way Wynd Yard

Suburb

State -- select ------- VIC NSW ACT QLD NT WA SA TAS Postcode

Concession Details

Are you entitled to an energy concession?   Yes      No     

Please complete your concession card details below, except if you live in South Australia.

If you live in SA and are entitled to a concession you will need to contact the Department of Families and Communities (DFC) on 1800 307 758 and complete an application. Your concession will apply once your application is processed by DFC.

Concession type -- select ------- Pensioner Concession Card Centrelink Health Care Card DVA Gold Card DVA Pension Concession Card DVA Gold Card (War Widows Pension only) DVA Gold Card (Special Rate TPI Pension only) DVA Gold Card (Extreme Disablement Adjustment)

Title -- select ------ Mr Mrs Miss Ms Dr Prof

First name

Last name

Card no.

Card start date (dd/mm/yyyy)

Card end date (dd/mm/yyyy)

I authorise Neighbourhood Energy and Centrelink or Department of Veterans Affairs to exchange my personal information during the term of this energy plan to verify eligibility for my concession.

Additional Information

I understand and agree that my Electricity will be transferred to Neighbourhood Energy as of my next meter read date unless I am already a customer of Neighbourhood Energy.

I understand and agree that Neighbourhood Energy can vary my rates, tariff structure, billing frequency and the terms of the energy plan at any time by writing to me.

I have read, understand and accept Neighbourhood Energy's Terms & Conditions.

I would like to receive electronic communications from Neighbourhood Energy from time to time in the future.