CONNECTION application

Power Connection Application Form

Complete this form if:

* Indicates required field

Who is making this Application *

Applicants Name *

Applicants Email Address *

The ES Number from the Orion Application *

The Address for the Connection *

Customer Name *

Customer Mailing Address *

Customer Phone Number *

Customer Email Address *

How many Connections are at this Address *

The Expected Date You will be ready for Power *

The Name of your chosen Power Retailer *

Your New Power Account or Customer Number *

The Name your Power Account is under *

Contact Phone Number for the Power Account *

Electricians Name *

Electricians Company Name *

Electricians Phone Number *

Electricians Email Address *

Southern Network Services LtdPO Box 3873Christchurch 8140Phone: 03 341 0125Email: admin@southernnetworkservices.co.nz