Origin | Country Energy - Energy Disconnection Request

* Select the type of energy you want to disconnect. (You can select both)

Electricity
Gas

Must be a business day. Please allow at least two business days notice.

e.g.21/05/2012 (dd/mm/yyyy)

* Customer number:

Title:

* First Name:

Middle Name:

* Surname:

Rural
Domestic
Business

* If Business, please enter:

* Trading name:

* ABN:

* Date of birth:

e.g. 16/03/1974

* Driver's licence number:

Or a password you nominate.

Property name:

National Metering Identifier: For electricity connection only

** NMI:

Note: The NMI number for the premises will be shown on a recent bill for that premises. It uniquely identifies your premises in the national electricity market. If you do not have that information, please complete the Service address box.

And / Or

Service address: For electricity or gas connection

** Street:

** City / Suburb:

** Postcode:

State:

* Street or PO Box:

* City / Suburb:

* Postcode:

State:

Yes
No

* If Yes, please enter breed(s)

Is there any issue that the meter reader should be aware of? e.g. Meter box behind a fence or gate.

** Home phone:

** Work phone:

** Mobile:

Email:

* Preferred method of contact:

Concerned about Privacy? Please be aware Country Energy will only use this information for the purposes outlined on this page. For more information on Privacy, please refer to our Privacy Policy.

1. Type of disconnection(s)

* Select the type of energy you want to disconnect. (You can select both)

2. Disconnection date

Must be a business day. Please allow at least two business days notice.

3. Your details

* Customer number:

Title:

* First Name:

Middle Name:

* Surname:

4. Customer type

* If Business, please enter:

* Trading name:

* ABN:

5. Proof of identity

* Date of birth:

* Driver's licence number:

6. Address that you want to disconnect

Property name:

National Metering Identifier: For electricity connection only

** NMI:

And / Or

Service address: For electricity or gas connection

** Street:

** City / Suburb:

** Postcode:

State:

7. Forwarding postal address

* Street or PO Box:

* City / Suburb:

* Postcode:

State:

8. Do you have a dog or dogs at the service address?

* If Yes, please enter breed(s)

9. Access to meter box

Is there any issue that the meter reader should be aware of? e.g. Meter box behind a fence or gate.

10. Please enter your contact details

** Home phone:

** Work phone:

** Mobile:

Email:

* Preferred method of contact: