Application for residential electricity connection / disconnection

Use this form if you have a residential site and you are applying for:

  1. Connection of electricity: You want to get electricity connected at your home address.
  2. Disconnection of electricity: You want your electricity disconnected, but do not require reconnection at a new address.
  3. Move-out/Move-in: You are moving and want to disconnect electricity at your old address and reconnect at your new address.

Fees and charges applicable for electricity connection are available on our Pricing and Tariffspage.

Required fields are marked with an asterisk (*)

1. How to complete and submit this form
What service do you require? *

Please note that connection and disconnection requests may take up to 3 business days to be processed. If your request is urgent please call us directly on 1800 JACANA (1800 522 262)

2. Your Details
Main Applicant

Please fill in at least one of the following fields: Phone business hours, Phone after hours or Mobile

3. Authorised contact person (other than applicant)

4. Disconnection address

Please fill in at least one of the following fields: Lot no, Unit no or Street no

Are there any special access restrictions, such as locked gates or dog(s)?

Address to send your final bill

5. Connection address

Please fill in at least one of the following fields: Lot no, Unit no or Street no

  

Are there any special access restrictions, such as locked gates or dog(s)?

Do you operate life support equipment at this address?
Please provide a medical certificate within 14 days of your life support status may be removed.
6. Acceptance

You acknowledge that by submitting this application you accept the standard terms and conditions applicable to the Jacana Energy Customer Contract - available at www.jacanaenergy.com.au/contract

Jacana Energy collects information to assist with the process of reviewing this application to connect, disconnect or alter a service. Jacana Energy will not be able to process the application if the required information is not provided. By submitting this application, you permit us to disclose the information contained in this application to other parties (who may be overseas), including third party providers and external agencies as described in our privacy policy which is located on our website at jacanaenergy.com.au/privacy. We may also use your personal information for direct marketing purposes. Our privacy policy explains what information we collect, why we collect it and how we protect that information. Please review the Privacy Policy if you require further information about your rights to access your personal information, how to make a privacy complaint or how to opt out of receiving direct marketing.

By submitting this application, you authorise Jacana Energy to conduct a credit check and use any relevant information obtained about your credit history to enable Jacana Energy to establish your creditworthiness, assess your application, assist you to avoid default and assist in the collection of overdue payments. Our Privacy Policy sets out specific details relating to how we handle credit information, in particular regarding the exchange of credit information with credit reporting bodies, guarantors, debt collectors, debt buyers and other parties. Please visit the Privacy Policy on our website for further information about the credit reporting bodies we use and how to contact them to discuss the handling of your credit information.