New connection to gas network

New connection

Site and gas use details

Lot no. of site:

Address of site:

Subdivision name:

Town / City:

Gas will be used for:

Construction connection details

This section can be completed by the site owner or Builder/Project Manager arranging the connection and meter installation

Building company:

Contact person for meter installation (eg Project Manager):

Mobile:

Email address: *

Postal address:

Estimate build completion date - note: 1 wwek advance notice is required for connection:

New gas account holder details

Salutation:

Full name of account holder: *

Current contact address:

Daytime phone number: *

Email address:

Terms and conditions: *

I have read and understood the terms and conditions for piped LPG supply

Word verification: * Type the characters you see in this picture.

Type the characters you see in the picture above; if you can't read them, submit the form and a new image will be generated. Not case sensitive.

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