Metering Application

Metering Application Form

* = Required field

SUPPLY ADDRESS DETAILS

Lot No

DP No

Unit No

Street No*

Street Name*

Suburb*

Postcode*

NMI*

Will you or anyone at the property depend on life support equipment?*

Yes No

MAIN ACCOUNT HOLDER

Do you already have an account for this site / NMI?*

Yes No

If yes, who is your retailer?*

YOUR DETAILS

ABN (if applicable)

Company Name (if applicable)

Title*

First Name*

Last Name*

Phone Number*

Email Address*

ID (please select preferred option)*

Drivers License Passport Medicare

Driver’s license/Passport/Medicare no:*

State of Issue*

DOB*

Mailing address (if different from supply address)