Staying Connected form

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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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Customer details

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*   dd/mmm/yyyy
  (Example 07/Aug/1990)

Contact details

 
(Example: 0x xxxx xxxx or 04xx xxx xxx)
 

Disaster affected

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Concession card details (if applicable)

By supplying us with your concession card details we can help ensure all eligible energy rebates are applied to your accounts.

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Account details

 
 
 

What can you afford to pay regularly towards your account(s)?

   
   
   

Start date for Payments to commence

 
 

(click on calendar to select date)
 
 
 

Add supporting document (not compulsory)

 
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