Application for Service

Your Name *

Date of Birth *

Entity type

Private

Company

Other

Company Name

Business Number

GST /Tax Number

Trust or Organisation name

Your Email *

Phone Number

Mobile *

Unit Number or ICP *

Broadband Internet *

Not Required

Broadband

We will create an invoice after we get this completed form back. Modem will be invoiced at $100 including GST for payment.

Mobile *

Not Required

Would like some options

We will contact you to see what kind of plan is best for you.

Account Holders ID (Optional)

Drivers License or Government issued ID
or Company Certificate from companies.govt.nz
(Optional)

Payment Type *

Download the forms from

Signed Payment form

Download and sign the chosen payment form and upload here

Is there anyone in your household/premise who for reasons of age/health/disability would have their health or wellbeing threatened by disconnection of electricity or, are you in financial hardship?

No

Yes

We recognise that electricity is an essential service. By letting us know that you or someone in your household has vulnerable needs on power helps us understand that being without power may be more challenging for your home than the average household. It’s important that we record this so we can consider these needs in our interactions with you. Having vulnerable needs on power recorded will not stop disconnections and outages occurring, so it’s important your household takes responsibility to have a back-up plan for managing power-off events.

Some examples of having vulnerable needs on power are (but not limited to) below:

An infant under the age of 12 months
An elderly person
Having a medical alarm with a battery back-up
A person with compromised health (without critical medical equipment)
A person considered to be in financial hardship.

Your Status at the property *

Owner

Tenant/Lessee

Agent

Agreement *

By ticking this box, you agree to our Terms of Use and Privacy Policy, and if you are signing up on behalf of the account holder, confirm that you are authorised to act on their behalf.

Request offer/Application for Service

Thank you for Joining!