Required *
Title
Choose a value
Mr
Mrs
Ms
Miss
Mx
First Name
Middle Name
Last Name
Phone Number
Mobile Number
Email
ID with a Drivers Licence or Passport Drivers Licence Passport
Drivers Licence Number
Drivers Licence Version (5b)
Passport Number (and we will call you for a copy)
Authorise another person Do you want anyone else authorised to discuss your account with us?
Yes
No
First Name
Last Name
Authorised Person's Date of Birth
Unit Number
Street Address
Suburb
Town/City
Postcode
Postal Address Different than Billing Address?
Yes
No
Unit Number
Street Address
Suburb
Town/City
Postcode
Are you moving into a new property?
Yes
No
Unit Number
Street Address
Suburb
Town/City
Are you changing suppliers?
Yes
No
Postcode
Are you a low user (i.e. you less than 8000 kwh per year and this is your primary residence)
Yes
No
Does anyone at your premises require critical medical support, where loss of electricity may result in serious harm?
Yes
No
(if yes who and what equipment)?
ICP Number or Meter Number
Are there any dogs or hazards at the property? If yes please specify.
Length of time at address
Residential Status
Choose a value
Owner
Tenant
Landlord
Real Estate Agent
Other
Please Specify
Please note a credit check may be required for new customers. If required do you consent to a credit check. What's this? a check performed by a company selling goods on credit to establish if a potential customer is creditworthy
Yes
No
Preferred payment method
Choose a value
Direct Credit
Direct Debit Variable
Direct Debit Fixed
Cheque
BNZ Branch
Credit Card Online
I acknowledge that I've read and accept the Electra Energy Terms and Conditions and consent to Electra Energy disclosing and using my personal information for the purposes of a credit check.
We value your privacy. Read our Privacy Policy .
