Residential Online Application Form

*denotes a required field

Please note that all fields may be deleted if a required field is not completed and you attempt to submit the form

Customer Information

Title:*

First name:*

Surname:*

Date of birth:*

Driver's licence number:

Contact Details

Mailing address:*

Suburb:*

State:*

Postcode:*

Home Phone*:

Work Phone:

Mobile:

Email:*

Are you the:* (tick box)

Installation Address Information

This is the address where your new gas meter will be installed, please fill in the details below

Property Identification Number (P.I.D.) (This can be found on your Rates Notice)

Is your installation address the same as your mailing address?  

Street number*:

Street name*:

Suburb*:

Postcode*:

Is the residential dwelling a:* (tick box)

A site inspection will be completed of your property to ascertain where the meter will be
located. On completion of the site inspection a 'Meter Location Card' will be placed in your letterbox. This card will contain a diagram of where the meter will be installed on your property (refer to clause 7.1 in Tas Gas Networks Residential Connection – Terms and Conditions).

Connection Information

Nominated connection date: (minimum of four weeks from your application)

Right-of-way consent required?* (tick box)

Description of any obstructions to service pipes or environmental issues (e.g. retaining walls, underground cables / water pipes, steep banks, chemical contamination, etc).**

** Additional charges may apply if it is necessary to incur additional costs in connecting you to natural gas due to obstructions such as those outlined above. See clause 4 and 5 (Tas Gas Networks Residential Connection – Terms and Conditions).

Appliance details / connection fee:* (tick applicable box)

Options 1 to 5 incur a $300 connection fee that will be charged to your first account.

 1. Ducted heating or hydronic heating 2. Hot Water and a Flued Heater 3. Hot Water only PLUS a Bayonet Point 4. Flued Heating only PLUS a Bayonet Point 5. Customers not meeting the requirements of the above options = $1,500 connection fee 6. Multiple Dwellings i.e subdivision or unit development = price on request

Appliances to be installed/converted* (type; make; model)

Appliance Retailer (where you purchased your appliances from)

Name:

Have you applied for finance with B&E Ltd?* (tick box)

Free Gas Code

Gasfitter Details

Name:*

Phone/mobile no:*

Standard Residential Tariff, Current at 01/03/2014

3.19 cents per MJ applies to all energy consumption for residential customers. This equates to 11.50 cents / kWh. Plus a fixed fee of 21.76 cents per day.

Standard Terms and Conditions

The standard terms and conditions under which you can purchase natural gas on this tariff are contained in Tas Gas Retail's Customer Charter.

Service Charges

A list of service charges is provided in our Customer Charter.

Variation of Tariff and Service Charges

Tas Gas Retail may vary these tariffs and service charges. Notification of any change will be published in Tasmania's three major newspapers on three successive days. Notice will be given 30 days prior to changes taking effect.

All prices listed on this form include GST.

Account Agreement

As the customer, I agree to abide by the terms and conditions detailed in Tas Gas Retail's Gas Supply Agreement, which is summarised in its Customer Charter (as provided). I also agree to abide by associated Tasmanian law. I consent to Tas Gas Retail providing information to Tas Gas Networks, who may contact me directly in relation to the connection process. The applicant(s) and guarantor(s) authorise Tas Gas Retail to disclose information contained herein to a credit reporting agency and to obtain consumer and commercial information permitted by the Privacy Act from a credit reporting agency and to use such information in order to assess this application for credit. Subject to provision of the Privacy Act, the applicant (and other parties named in this application) authorises Tas Gas Retail to seek and obtain information from other credit providers for approving this application or managing this account. These authorisations shall remain in force for the duration of the credit contract.

I authorise Tas Gas Networks to carry out the service connection and the necessary works to the property stated in the installation information section of this application form and agree to the Tas Gas Networks Residential Connection – Terms and Conditions and the Tas Gas Retail Customer Charter and I acknowledge and agree that the terms and conditions form part of this application.

I agree

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