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Customer Details

First Name*

Surname*

Email*

Date of Birth*

Mobile*

Phone

Business Phone

Property (Supply Address)

Disconnection Date*

Unit Number*

Address*

Unit Number Street Address City State / Province / Region ZIP / Postal Code Country

Forwarding Address

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Declaration

I declare that I am authorised customer and that I apply for disconnetion of electricity to the above address on the terms and conditions set out in this document.
I consent to Arc Energy Group or its representative taking all steps necessary to disconnect the service, and grant Arc Energy Group or its representative access to the property for the purpose of obtaining a final meter reading.
I acknowledge that I am responsible for the payment of electricity supplied to the property until such time that I give Arc Energy Group at least 3 business days written notice of the date on which I vacate or intend to vacate the property, and provide a forwarding address to which a final bill may be sent. If no forwarding address is provided then i agree that i will be responsible for any changes incurred under the Intermediary Sale of Energy Agreement until such time that i provide a forwarding address to Arc Energy Group.
I understand that a final meter read fee will apply to my vacation of the premises and that this fee will appear on my final account.

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