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 *

Is this your Mobile Number *

Yes

No

Mobile *

ICP *

Connection Date *

Address *

Address 2

Suburb

Town/City

Country

Post Code *

Address for ICP service *

Address 2 - ICP

Town/City - ICP

Suburb - ICP

Country - ICP

Post Code - ICP *

Postal Address

Same as above

PO Box

Other Address

Other Address 2

Other Town/City

Other Suburb

Other Country

Other Post Code

PO Box Number

PO Box Street

PO Box Town/City

PO Box Suburb

PO Box Country

PO Box Post Code

Invoice Delivery *

eMail

Post (fee applies)

Standard Residential

Everyday Plan

Time of Use

Go Green

Check Plan Prices

High User

Check Plan Prices

Home Business/Commercial

SOHO

EHO/Retailer

High User

SOHO = Small office/Home Office
EHO/Retailer = Enterprise Home office

Check Plan Prices

Farm/Industrial

FH - Everyday

TOU - FB

Both - FH/FB

Industrial - TOU

TOU = Time of Use - FH = Farm House
FB = Farm Buildings

Check Plan Prices

Bundle *

None

Broadband

Broadband + Mobile

We will contact you to confirm plan speed and availability

Broadband Fibre Plan

Basic / Coffee Latte

Fast / Cappuccino

Max / Espresso

Check Plan Prices

Mobile Speed

5GB / Earl Grey

50GB / Green Tea

100GB / Chamomile Tea

GR-NZ 50GB / Jasmine Tea

Check Plan Prices

Recent Electricity Bill *

Account Holders ID *

Drivers License or Government issued ID
or Company Certificate from companies.govt.nz
(if not uploaded we will request from you)

Payment Type *

Direct Debit

Credit Card

Paypal

After Pay

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.

Application for Service

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