Access water filling stations

Complete this application to receive approved access to one of our water filling stations

If you require access to one of our water filling stations, please complete this form to gain approval and receive an access swipe card.

This form is for:

Customers located in the Darwin and rural areas, Katherine and Tennant Creek without access to a bore or town water

Customers requiring a swipe card for a water filling station

Do not use this form if you are located in a remote community

Before you begin, tell us what you need

Which type of customer are you?

How many swipe cards do you need? *

Business cardholder details

Customer ID (if known) This will be a number between 5 and 9 digits long, usually beginning with 0

Business name *

Business ABN number *

Business phone number *

Full name of authorised person on account * This person will be listed as the account holder

Business billing address * This is where we will send bills

Email address *

Phone number *

Residential cardholder details

Customer ID (if known) This will be a number between 5 and 9 digits long, usually beginning with 0

First name * This person will be listed as the new account holder

Last name * This person will be listed as the new account holder

Phone number *

Email address *

Postal address * This is where we will post your card

Date of birth *

Day Month Year

Please provide one form of ID *

Identification number * For example, if you selected drivers license above you would insert your drivers license number here

Issuer of identification * For example, the State or Territory where you identification is issued

Add another card holder?

Add another cardholder

First name * This person will be listed as the new account holder

Last name * This person will be listed as the new account holder

Phone number *

Email address *

Date of birth *

Day Month Year

Please provide one form of ID *

Identification number * For example, if you selected drivers license above you would insert your drivers license number here

Issuer of identification *

Please confirm the following:

Monthly billing *

I/We agree that I/we will be billed monthly (end of each month).

I/We understand that in accordance with the Privacy Act: *

Unpaid debts more than 60 days overdue 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.

Unused cards should be returned *

Once I/we no longer require the swipe card(s) I am to post it to GPO Box 3596, Darwin NT 0801

I/We understand and accept that Power and Water Corporation may: *

Store personal information in paper and electronic formats. Power and Water takes all reasonable steps to ensure the security of all customer data. Personal information is maintained in a secure environment accessed only by authorised personnel. However, any data sent over the internet or store on internet servers cannot be guaranteed to be fully secure. These activities are undertaken at your risk.

I/We understand and accept that this may *

take up to seven business days to process.

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Access water filling stations

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