YOUR SITE

Connection Type

Power Supply Accounts Gas Supply Accounts

Are you an existing customer?

No Yes

Are you moving into the property? Electricity – Move in charges $11.04 (for Ausgrid) $38.09 (for Endeavour Energy) $88.72 (for Essential Energy)

Transfer Move In

Move In Date

This form is not used for existing customers. Please call us on 1300 426 594 to discuss your expanding service requirements.

Supply Address

Enter the first line of the address, or site NMI if you know it The site's NMI will be shown on your electricity bill. If you don't have a current electricity bill for the site, just enter the address instead.

Select Manual Entry to Manually Enter Site Address Enabling manual entry will disable the search

Enable Manual Entry

Lot Number

Floor Type

Number

Unit Type

Number

Street Number

Suffix

Street

Street Type

Suffix

City / Suburb

State

Post Code

DETAILS

Are you enrolling a private residence, or a commercial site?

Residential Company

What sort of site are you signing up?

Rental Own

Business Name

ABN (Australian Business Number)

ACN (Australian Company Number)

Industry

Your Details

Title

First Name

Last Name

Mobile

Land Line

Retype Email

Date of Birth

Type of ID

ID Number

Would you like to add an additional contact?

No Yes

Title

First Name

Last Name

Mobile

Land Line

Retype Email

Date of Birth

Postal Address

Street Address

Suburb

State

Post Code

OTHER INFO

Billing Options

ESTIMATED MONTHLY BILLING AMOUNT

My bills will be sent to me via

Email Post ($2 charge may apply)

Direct Debit

Would you like to set up a direct debit?

No Yes

Bank Account Name

Bank

Branch

Account No Enter your full bank account number, in the format 'XXXXXX-XXXXXXXXXx'. (Exact number of digits may vary.)

Concession Details

Concession Card?

No Yes

Concession Details

Card Type

Card Number

Start Date

Expiry Date

First Name

Middle Name

Last Name

Medical/Vulnerable

Is anyone residing at this address on a life support machine or medical equipment requiring energy supply?

No Yes

REVIEW

Review Your Application

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By signing here I understand and agree to the energy service described above

I have read and accept the 1st Energy market retail contract terms and conditions which include our privacy policy and understand and give my explicit informed consent to the key terms and conditions set out in my application and below.

By accepting this offer you are providing your explicit informed consent to enter into a market retail contract for the supply of electricity with 1st Energy.

You understand you have a 10 Business Day Cooling Off Period starting from the day after you receive your Welcome Pack, this includes information about the plan, how to cancel and your rights under Australian Consumer Law.

You Understand 1st Energy will conduct a credit check and will let you know if there is a problem.

You provide your explicit informed consent for 1st Energy to communicate with you via electronic communication and to bill your account monthly by email.

You give your explicit informed consent for 1st Energy to vary the rates, charges and the terms of your energy plan at any time by informing you in writing at least 5 business days before they apply or if in Queensland by at least 10 business days before the new tariffs and charges apply.

YOUR SITE

Supply Address

DETAILS

Your Details

Postal Address

OTHER INFO

Billing Options

Direct Debit

Concession Details

Concession Details

Medical/Vulnerable

REVIEW

Review Your Application

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