Pagewood Electricity Move In Form

Do you want your connection within 2 business days?
What day would you like your connection?

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Sub Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Sub Time

:HourMinutesAM/PM Option
Account Type
Customer Type

I.D
Personal Identification Type
Authentication Number
Date Of Birth Day/Month/Year
xx/xx/xxxx
Upload a File
Please Take Photo Of Your ID (If screen is black press the turn camera around button top right corner) Cancelof

Life Support
Do you or anyone who will be living with you at this premises require life support equipment?

Same Business Day Energisation If Form Received Before 2pm Or The Following Business Day If After 2pm (Not Including Sat & Sun)$107.42 AUD

Move In Meter Reading Fee$15.00 AUD

Subtotal Tax Total $0.00 AUD

Payment Method
Credit	Express

Debit Arrangements
Payment Method
Please choose a method of payment:
Type
Bank Code / BSB
Name On Account
Account Number
First 4 digits
The rest of the digits
Expiry Date
dd/yy
Name On Account
Payments will appear on your statement as UTILITY BILL

I / We authorise Ezidebit Pty Ltd ACN 096 902 813 (User ID No 165969) to debit my/our account at the Financial Institution identified above through the Bulk Electronic Clearing System (BECS) in accordance with the Debit Arrangement stated above and this Direct Debit Request and as per the Ezidebit DDR Service Agreement (Ver 1.12) provided.
Terms & Conditions

Hardship Policy
AER Factsheet
Exempt Customer Factsheet
Family Violence Policy
Feedback
Did you know that this is the only building that offers prepaid and postpaid utility solutions?
Would you like to find out how prepayment would benefit you?
How was your sign up experience?
Should be Empty:

Account Type