Disconnection application

Account holder details

Account number *

First name *

Last name *

Date of Birth *

Drivers license

Contact number *

Property Address to be disconnected *

Vacating details

Moving out date *

Please note: Disconnections are available Monday-Friday excluding Public Holidays and require 24 business hours notice. A Disconnection fee of $110 including GST may apply.

Forwarding address details

The addresses below will be used to send your final bill and any notices.

Email address *

Postal forwarding address *

Please enter a postal address only.

Please send my final bill and notices via *

Email address

Postal address

As the account holder, I hereby declare that the details entered above are true and correct to the best of my knowledge. I understand that vacating the premises is subject to the Terms & Conditions of my contract.

COVID-19 check list

Have you, or any household members returned from any interstate/overseas travel in the last 14 days? *

Yes

No

Have you been in contact with a person, or you yourself, confirmed positive with covid-19? *

Yes

No

Do you have symptoms of illness, cough, fever, shortness of breath or any other symptoms? *

Yes

No

Have you recently undertaken covid-19 testing? *

Yes

No

If answered yes to the previous question, have you received your results?

Yes - Positive

Yes - Negative

I have not received my results