Small Business Moving Out Request/Disconnection Request

Utilities to be disconnected
- Electricity
- Natural Gas
- Non-drinking Water
Customer Details
Account Address*
Street Address Address Line 2 City State Post Code
Electricity Account #
Gas Account #
Non-drinking Water Account #
Company Name*
Authorised Person Name*
Contact Number*
Moving Out Date*
DD slash MM slash YYYY
Please note: Disconnections available Monday-Friday excluding Public Holidays. 24 hours notice required.
Contact Information
Email Address*
Postal Address*
If future address is unknown please enter a preferred address for notices.
Please send my final bill and notices via*
- Email address
- Postal address
Acknowledgement*
As the account holder, I hereby declare that the details entered above are to the best of my knowledge true and correct . I understand that vacating the premises is subject to the Terms & Conditions
Phone
This field is for validation purposes and should be left unchanged.

Customer Details