Meter Request Form

Title

Mr Mrs Ms Miss

First Name

Last Name

Street Address

Suburb

State

Postcode

Phone

Life Support

Yes No

Retailer

NMI

Drivers Licence

Meter Numbers

Service Type

Number Of Phases

Off Peak / Controlled Load:

Yes No

Work Request Type

Please attach any relevant documents. i.e. copy of latest power bill, site maps, copy of drivers licence

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Name

Phone

Email

Address

Type of Job

I'm a Builder

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