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
How would you like to receieve your swipe card(s)? *
Business cardholder details
This will be 9 digits
This person will be listed as the account holder
This is where we will send bills
Residential cardholder details
This will be 9 digits
This person will be listed as the new account holder
This person will be listed as the new account holder
This is where we will post your card
Date of birth *
For example, if you selected drivers license above you would insert your drivers license number here
For example, the State or Territory where you identification is issued
Add another card holder?
Add another cardholder
This person will be listed as the new account holder
This person will be listed as the new account holder
Date of birth *
For example, if you selected drivers license above you would insert your drivers license number here
Please confirm the following:
Monthly billing *
I/We understand that in accordance with the Privacy Act: *
Unused cards should be returned *
I/We understand and accept that Power and Water Corporation may: *
I/We understand and accept that this may *