ISOLATION appl box

Power Isolation Application Form
Complete this form if you require the power turned off from an Orion Box.

* Indicates required field

The Address for the Isolation *

Applicants First and Last Name *

Applicants Phone Number *

Applicants Email Address *

Your role as the Applicant *

Has an Orion Consent been applied for

Enter the Consent Number or Enter NO *

Is this Residential or Business *

What is the reason for the Isolation *

Requested Isolation Date *

Requested Re-connection Date *

Is this a t.joint YES or NO or DONT KNOW *

Will any Electrical Work be Completed *

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