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Connection Address:

  • Unit/shop number (*)

  • Street Number(*)

  • Street name (*)

  • suburb (*)

  • state (*)

  • Post code (*)

Postal Address

  • Postal Address

  • Unit/shop/po box no.

  • Street Number (*)

  • Street Name (*)

  • Suburb (*)

  • State (*)

  • Post code (*)

Account Contact Details

  • Business Name (*)

  • ABN (*)

  • Title (*)

  • First Name (*)

  • Last Name (*)

  • Position (if business)

  • Title (*)

  • First Name (*)

  • Last Name (*)

Contact Numbers

  • Home Phone

  • Mobile Phone

  • Work Phone (*)

  • Email Address (*)

Contact Numbers

  • Home Phone

  • Mobile Phone (*)

  • Work Phone

  • Email Address (*)

Personal Identification

  • Licence Number (*)

  • State Issued (*)

  • License Expiry (*)


  • Passport Number (*)

  • Country Issued (*)

  • Passport Expiry (*)


Secondary Contact

  • Title (*)

  • First Name (*)

  • Last Name (*)

  • Home Phone

  • Mobile (*)

  • Work

  • Email Address (*)

  • Date of Birth (*)


Leasing Agent

  • Company (*)

  • Contact Name (*)

  • Street Address

  • Suburb

  • State

  • Post Code

  • Phone (*)

  • Mobile

  • Email Address(*)

Supply Commencement

  • Move in/lease start/settlement date (*)


Internet Broadband Service

Click here or contact Harbour ISP on 1300 366 169 to find out more about their great value internet plans.

  • Type Of Service

  • Internet Plan

  • Contract Period

Bill delivery

  • Billing Method (*)

Concessions and rebates


  • Concession Card Type (*)

    Concession card number (*)

    I authorise:

    - Arc Energy Corporation Pty Ltd T/A Arc Energy Group to use Centrelink Confirmation   eServices to perform a Centrelink/DVA enquiry of my Centrelink or Department of Veterans’ Affairs customer details and concession card status to enable the business to determine if I qualify for an energy rebate.

    - Services Australia (the agency) to provide the results of that enquiry to Arc Energy Group.

    I understand that:

    - The agency will disclose personal information to Arc Energy Group including my name, address and concession card type and status to confirm my eligibility for relevant energy rebate.

    - This consent, once accepted, remains valid while I am a customer of Arc Energy Group unless I withdraw it by contacting Arc Energy Group or the agency.

    - I can get proof of my circumstances/details from the agency and provide it to Arc Energy Group so my eligibility for relevant energy rebate can be determined.

    - If I withdraw my consent or do not alternatively provide proof of my circumstances/details, I may not be eligible for the energy rebate provided by Arc Energy Group.

    Acceptance (*)


    Terms and conditions

    The sale of electricity to the Customer is subject to and governed by this Customer Agreement Form and by Arc Energy's Electricity Supply Agreement Terms and Conditions and Pricing fact sheet. The electricity charges payable by the Customer for the supply of electricity under the Electricity Supply Agreement are also set out in our website at www.arcenergygroup.com.au

    An Arc Energy representative will connect the electricity and/or hot water at the premise. A connection fee will apply, which will be added to your first invoice.

    If the signatory is signing on behalf of a Company or partnership, the signatory warrants that he or she is authorised to do so. By signing, the signatory warrants that he or she has read, understands and agrees to Arc Energy's Electricity Supply Agreement Terms and Conditions.

    Acceptance (*)

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