Request a payment plan- Residential

Use this form to request a payment plan to pay small amounts over an extended period.

Information received via this online form is processed during business hours, Monday to Friday, 8:00am to 5pm.

Customers that are eligible for pay deductions through Services Australia can have the deductions applied by calling Services Australia directly or contacting Jacana Energy.

Required fields are marked with an asterisk (*)

Your details

Account number

First name *

Last name *

Date of birth *

Phone number *

Email address

Service address *

Payment arrangement details

How often would you like to pay? *

What is the maximum amount you can afford to pay? *

Per week, fortnight or month, depending on your selection at the previous question

On what date would you like your payment arrangement to start? *

Do you agree to Jacana Energy calculating the duration of your payment arrangement based on what you can afford to pay? *

Your current situation

Are you unemployed? *

Are you income-managed? *

Acceptances

By submitting this form you agree to the following terms: *

I confirm that the information provided in this form is true and accurate.

I give permission to Jacana Energy to set-up a payment arrangement for my account based on the information submitted in this form.

I understand that my payment arrangement can be varied as required and I agree to notify Jacana Energy immediately if my circumstances change.I understand that my payment arrangement can be varied as required and I agree to notify Jacana Energy immediately if my circumstances change.

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