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Customer Type
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Company Name
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Email
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Postal Address
Suburb
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Queensland
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Victoria
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South Australia
Supply Address
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Secondary Contact
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Secondary Name
First Name
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Secondary Phone
Secondary DOB
MM slash DD slash YYYY
Entity Name
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ABN
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ACN
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NMI
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MIRN
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Life Support
*
Yes
No
Concession
*
Yes
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Card Number
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Drivers Lic
*
Yes
No
Number
EXP
MM slash DD slash YYYY
DOB
MM slash DD slash YYYY
State Issued
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New South Wales
Queensland
Tasmania
Victoria
Western Australia
South Australia
Sales Rep Full Name
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Channel Partner
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Select Channel Partner here...
Solarcell Energy
Homiii
Energy Upgrade AU
My Channel Partner
Blue Matrix
Zero Energy
Interested in:
Energy
Solar
Batteries
Internet
Health
Upload Power Bill (Front & Back)
Drop files here or
Select files
Max. file size: 256 MB.
*
Have you attached a recent copy of your bill?
Please tick the boxes you authorize Solarcell to act on your behalf
*
Obtain new pricing contract for the above addresses/sites from our current or new electricity retailer
Δ
"
*
" indicates required fields
Customer Type
Residential
Commercial
SOHO
Customer Name
First Name
Last Name
Company Name
Phone
Email
*
Postal Address
Suburb
Postal Code
State
Please select...
New South Wales
Queensland
Tasmania
Victoria
Western Australia
South Australia
Supply Address
Add
Remove
NMI
Add
Remove
MIRN
Add
Remove
Secondary Contact
*
Yes
No
Secondary Name
First Name
Last Name
Secondary Phone
Secondary DOB
MM slash DD slash YYYY
Entity Name
Add
Remove
ABN
Add
Remove
ACN
Add
Remove
Supply Address
Add
Remove
NMI
Add
Remove
MIRN
Add
Remove
Life Support
*
Yes
No
Concession
*
Yes
No
Card Number
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Drivers Lic
*
Yes
No
Number
EXP
MM slash DD slash YYYY
DOB
MM slash DD slash YYYY
State Issued
Please select...
New South Wales
Queensland
Tasmania
Victoria
Western Australia
South Australia
Sales Rep Full Name
*
Channel Partner
*
Select Channel Partner here...
Solarcell Energy
Homiii
Energy Upgrade AU
My Channel Partner
Blue Matrix
Zero Energy
Interested in:
Energy
Solar
Batteries
Internet
Health
Upload Power Bill (Front & Back)
Drop files here or
Select files
Max. file size: 256 MB.
*
Have you attached a recent copy of your bill?
Please tick the boxes you authorize Solarcell to act on your behalf
*
Obtain new pricing contract for the above addresses/sites from our current or new electricity retailer
Δ
