Commercial natural gas connection form

* Required fields

What service do you need?

Service requested *

Installation

New installation (service line & meter kit)

Addition/Alteration

Meter upgrade

Meter downgrade

Meter kit only

Removal/Abolishment

Removal of gas meter

Removal of gas meter and service line

Customer information

The 'Customer' is defined as the person responsible for the gas account, e.g. business owner. The person applying for the gas connection service will be responsible for the payment of the ActewAGL natural gas bill including the quarterly supply fee and usage charges payable from the date of meter installation.

First name *

Surname *

Date of birth * dd/mmm/yyyy
(Example 21/Nov/1994)

Postal address

Address *

Suburb *

State *

Postcode *

Country

Contact details (at least one phone number is required)

Daytime phone number

After hours phone number

Mobile

Email address

Installation (premises) information

Lot/block/section

Unit number

Street number *

Street name *

Suburb *

State *

Postcode *

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

Plumber details

Name *

Plumber's licence number *

Phone/mobile number *

Meter position

physical supply of natural gas example image

Preferred meter position *

Example: On the right-hand side of the house as viewed from the street (Crawford street), 1.5 meters from the front corner of the house.

Metering pressure * 2.75KPA
(Low)5KPA or 35KPA
(Medium)100KPA
(High)

Appliance details

Note: it is important that we know your total appliance details for correct meter sizing.

Appliance description	Appliance new or existing	Quantity	Hourly rate (MJ/hr)	Usage % capacity	Hours used per day	Days used per week	Weeks used per year	Annual usage
		Please enter an amount Quantity must be numeric.	Please enter the hourly rate (MJ/hr) Hourly rate must be a decimal number.	Please enter usage % capacity. Please enter a value between 0 and 100.	Please enter a value between 0 and 24.	Please enter a value between 0 and 7.	Please enter a value between 0 and 52.

Please indicate the appliances you are connecting.

Service Application Fee/Authority to Perform Work

There is no cost for a standard meter installation, meter kit, meter upgrade/downgrade. For any non-standard charges you’ll receive a quote in writing.

A variable fee is charged by the distributor for the Removal/Abolishment service. You will be notified of these charges prior to commencement of work.

* Non-standard services are subject to additional charges. You will be advised of any fee variation prior to the commencement of work.

Terms and conditions

Authority to perform work is not required because this is now covered in the acceptance of the model standing offer (see below). The acknowledgment on the existing form about the on-site is now contained in the “Your Acceptance” section in the full terms and conditions.

Your acceptance

Acceptance of model standing offer

I hereby authorise ActewAGL Retail to arrange, on my behalf, for my Distributor to carry out the Basic Connection Service to the Premises and acknowledge that by submitting this form, I am indicating that the terms set out in my Distributor's model standing offer for basic connection service ( a copy of which can be requested from my Distributor) are acceptable to me.

Credit check

I authorise ActewAGL to conduct a credit check and use any relevant information obtained about my credit history to enable ActewAGL to establish my creditworthiness.

By submitting this application, I acknowledge that this information may be used to assess my application; to assess the credit which may be provided; to assist me to avoid default and to notify other credit providers of my default; to assist in the collection of overdue payments and to provide information to any person who proposes to guarantee or has guaranteed payment of my account.

ActewAGL's Credit Reporting Policy is available at www.actewagl.com.au/legal/policies/credit-reporting-policy.

I agree to the terms and conditions.

You must agree to the terms and conditions before the application can be submitted.

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.

Natural gas service application – commercial