Application for removal of gas supply

* Required fields

Work to be performed

Work to be performed I request for ActewAGL to arrange for the Distributor to remove the gas meter/s only at the nominated Supply Address. A fee is charged by the Distributor.
I request for ActewAGL to arrange for the Distributor to remove the gas meter/s and disconnect the service line at the street located at the nominated Supply Address. A fee is charged by the Distributor.

Work site details

Unit number

Floor number

Street number *

Street name *

Suburb *

Postcode *

ActewAGL only services the postcodes in the list, if you live outside this area please contact your retailer.

Meter identification registration number(s)
found on meter(s) *

Safe access to meter(s) * YesNo

Please note: The distributors will not call you to make access arrangements; please ensure that there is safe access to the meter. Completion of the meter and service disconnection can take up to 5-10 working days. It is your responsibility to ensure safe access is available from the time the request is made until the completion of the meter removal and disconnection at the street has taken place.

Account holder details

Account name

Account number

Postal address

Postal address suburb

Postal address state

Postal address postcode

Postal address country

Contact phone number

Mobile

Note: By giving authority the Account Holder authorises the performance of the work indicated above. Authority is given to bill the party named in the section below for the work.

Authorisation of account holder

Invoice instructions

Who will be billed for the work? *

Account holder
Third party (ie Demolition company or builder)

Corporation name
(if applicable)

ACN/ABN
(if applicable)

Individual's given name *

Individual's surname *

Title

Date of birth * dd/mmm/yyyy
(Example 20/Apr/1994)

Postal address *

Postal address suburb *

Postal address state *

Postal address postcode *

Postal address country

Contact phone number *

Mobile

Note: By authorising below the party nominated above is accepting charges for the works indicated at the top of this form.

Authorisation of payer

The payer must agree to the declaration before you may submit the application.

Disclosure of credit information to a credit reporting agency (Privacy Act 1988) – This Application constitutes a contract for consumer credit. We may give credit information to a credit reporting agency for the purpose of obtaining a consumer credit report about you and/or allowing the credit reporting agency to create or maintain a credit information file containing information about you. This information may be given before, during or after the provision of credit to you. This information is limited to: your name and address; the fact that you have applied for credit under this Application; the fact that we provide credit to you; the existence of any loan repayments which are overdue by more than 60 days and for which debt collection action has started; information that, in our opinion, you have committed a serious credit infringement; or information about cheques drawn by you for $100 or more which have been dishonoured more than once.

Your privacy is important to us and we are committed to handling your personal information in accordance with the Privacy Act 1988 (Cth). Our Privacy Policy sets out how we collect, hold, use and disclose your personal information. Read ActewAGL's privacy policy in full here.

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