IES Network Connection Form

Applicant Details:
Applicant Type:: ResidentialBusiness
This is the type of premises where the system will be installed
Number of applicants:: Please include all names that appear on your electricity account
Title:
Name:: First Name:

Last Name:
Customer phone:: Enter a 10 digit phone number, including area code, without spaces
Customer email address:: The applicants email address will be used to provide communication about the application process and status updates
Preferred contact method:: EmailPhone
Ergon Energy will correspond with you by email with regard to your IES application and connection. If approved, network agreements will be mailed to you for signing
Premises Details:
Premises Address:: Address where the IES will be located; please refer to the premises address on your electricity bill
Suburb/Town:
State:
Postcode:
Is your postal address different to the address above?:
Postal Address:
Postal Suburb/Town:
Postal State:
Postal Post Code:
Is your premises a retirement village, gated community or similar?:: YesNo
Who is your electricity Retailer for this application?:
Account Number:
National Metering Identifier (NMI):: This is an 11 digit number found on your electricity account
Registered plan number:: Refer to your rates notice
Lot Number:: Refer to your rates notice
Spam Verification: