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IMPORTANT NOTE: Credit Card Payments may take up to three working day to process. Please note that in accordance with the Privacy Act, details of uncontrolled debts, more than 60 days overdue and identifying particulars may be referred to a credit reporting agency and then become available to other credit providers. Unpaid Power and Water accounts could affect your credit rating.
I/We, being the person(s) named below under customer details, hereby make application for supply under the terms and conditions applicable pursuant to the Power and Water Customer Contract.
After hours connection (after 5.30pm) will incur a $67 connection fee, please call 1800 245 092.
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If this isn't what you were looking for you might be interested in connecting your business.
Name*
Date of Birth* 12345678910111213141516171819202122232425262728293031 JanFebMarAprMayJunJulAugSepOctNovDec 190019011902190319041905190619071908190919101911191219131914191519161917191819191920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995
Secondary Name
Secondary Date of Birth 12345678910111213141516171819202122232425262728293031 JanFebMarAprMayJunJulAugSepOctNovDec 192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994
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Email Address*
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Street*
Town/City*
State* -- Choose State/Territory --ACTNSWNTQLDSATASVICWA
Post code*
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Identification* Drivers LicencePassportPensioner Concession CardOther photo id
Identification Number*
Issuer of Identification*
Name of Employer
Address of Employer
Name of Landlord or Agent
Address of Landlord or Agent
Please note that a $56 fee will apply to all connections
Are you currently a Power and Water customer?
Account Number* Current Address
Have you previously been a Power and Water Customer
Account number or previous address which services were supplied
Are you a holder of a Norther Territory Pensioner Concession card
Pension Concession Card No.* Pension Concession Card expiry date 12345678910111213141516171819202122232425262728293031 JanFebMarAprMayJunJulAugSepOctNovDec 2012201320142015201620172018201920202021202220232024202520262027202820292030
Lot, Unit, House no. *
Suburb/City*
Post Code*
Is there currently power at the address YesNoUnknown
Connection start date required* 12345678910111213141516171819202122232425262728293031 JanFebMarAprMayJunJulAugSepOctNovDec 201220132014
Are there any access issues?
Special Access Instructions Name and contact number for someone available on connection day. If yes, Power & Water will be unable to complete your connection request. Arrangements should be made for safe access. If Power & Water is required to complete more then one trip, additional fees will apply.
Access Difficulty -- Leave Empty --DogLocked GatesOther
Are there any special reasons why electricity cannot be interrupted without notice? YesNoFor example life support systems or manufacturing processes. You are required to supply evidence, we will contact you to discuss if yes.
In accordance with the Privacy Act, details of uncollected debts more than 60 days overdue & any identifying particulars may be referred to a credit reporting agency and then become available to other credit providers.
Privacy Policy*
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