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You can provide another address here if you like\",\"type\":\"control_text\"},null,{\"name\":\"paperlessBilling\",\"qid\":\"65\",\"text\":\"Paperless Billing\",\"type\":\"control_checkbox\"},{\"name\":\"attatchSupporting66\",\"qid\":\"66\",\"text\":\"Attatch Supporting Evidence\",\"type\":\"control_fileupload\"},{\"name\":\"doubleclickTo\",\"qid\":\"67\",\"text\":\"Please tell us if you have any life support or medical cooling equipment at your supply address. If you do, we will inform the local area distributor so that they can prioritise your energy reconnection in the event of a power outage. Please note that we are required to verify your use of life support equipment.\",\"type\":\"control_text\"},{\"name\":\"youCan\",\"qid\":\"68\",\"text\":\"You can provide further details here if needed\",\"type\":\"control_textarea\"},{\"name\":\"clickTo69\",\"qid\":\"69\",\"text\":\"Step 5: Your Agreement &amp; Understanding\",\"type\":\"control_head\"},null,{\"name\":\"doubleclickTo71\",\"qid\":\"71\",\"text\":\"We require your explicit and informed consent to proceed. Please read our terms and conditions before proceeding.\\nImportant notice to customer: You have the right to cancel your new energy contract within 10 business days from the day you receive your Welcome Pack from us. Details about your rights to cancel the contract are set out in the Welcome Pack you will receive.\",\"type\":\"control_text\"},null,null,null,null,null,null,null,null,null,{\"name\":\"explicitInformed\",\"qid\":\"81\",\"text\":\"Explicit Informed Consent\",\"type\":\"control_checkbox\"},{\"name\":\"clickTo82\",\"qid\":\"82\",\"text\":\"NSW Life Support Rebate APPLICATION FORM.\\nPlease complete the application and send a scanned copy back to Flow.\",\"type\":\"control_text\"},{\"name\":\"clickTo83\",\"qid\":\"83\",\"text\":\"Energy Services for The Pinnacle&nbsp;include Electricity and Hot Water.\\nIf you would like&nbsp;Network And Thermal Services only please contact our Customer Support team on 1300 803 803\",\"type\":\"control_text\"}]);}, 20); \n<\/script>\n<\/head>\n<body>\n<form class=\"jotform-form\" action=\"https:\/\/submit.jotform.co\/submit\/51527874868876\/\" method=\"post\" enctype=\"multipart\/form-data\" name=\"form_51527874868876\" id=\"51527874868876\" accept-charset=\"utf-8\">\n  <input type=\"hidden\" name=\"formID\" value=\"51527874868876\" \/>\n  <div class=\"form-all\">\n    <ul class=\"form-section page-section\">\n      <li id=\"cid_59\" class=\"form-input-wide\" data-type=\"control_head\">\n        <div class=\"form-header-group \">\n          <div class=\"header-text httal htvam\">\n            <h2 id=\"header_59\" class=\"form-header\" data-component=\"header\">\n              Step 1: Your Details for The Pinnacle Electricity\n            <\/h2>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_fullname\" id=\"id_35\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_35\" for=\"first_35\">\n          Your Name\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_35\" class=\"form-input jf-required\">\n          <div data-wrapper-react=\"true\">\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n              <input type=\"text\" id=\"first_35\" name=\"q35_yourName35[first]\" class=\"form-textbox validate[required]\" size=\"10\" value=\"\" data-component=\"first\" required=\"\" \/>\n              <label class=\"form-sub-label\" for=\"first_35\" id=\"sublabel_first\" style=\"min-height:13px;\"> First Name <\/label>\n            <\/span>\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n              <input type=\"text\" id=\"last_35\" name=\"q35_yourName35[last]\" class=\"form-textbox validate[required]\" size=\"15\" value=\"\" data-component=\"last\" required=\"\" \/>\n              <label class=\"form-sub-label\" for=\"last_35\" id=\"sublabel_last\" style=\"min-height:13px;\"> Last Name <\/label>\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_birthdate\" id=\"id_18\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_18\" for=\"input_18\">\n          Birth Date:\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_18\" class=\"form-input jf-required\">\n          <div data-wrapper-react=\"true\">\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n              <select name=\"q18_birthDate18[day]\" id=\"input_18_day\" class=\"form-dropdown validate[required]\" data-component=\"birthdate-day\">\n                <option>  <\/option>\n                <option value=\"1\"> 1 <\/option>\n                <option value=\"2\"> 2 <\/option>\n                <option value=\"3\"> 3 <\/option>\n                <option value=\"4\"> 4 <\/option>\n                <option value=\"5\"> 5 <\/option>\n                <option value=\"6\"> 6 <\/option>\n                <option value=\"7\"> 7 <\/option>\n                <option value=\"8\"> 8 <\/option>\n                <option value=\"9\"> 9 <\/option>\n                <option value=\"10\"> 10 <\/option>\n                <option value=\"11\"> 11 <\/option>\n                <option value=\"12\"> 12 <\/option>\n                <option value=\"13\"> 13 <\/option>\n                <option value=\"14\"> 14 <\/option>\n                <option value=\"15\"> 15 <\/option>\n                <option value=\"16\"> 16 <\/option>\n                <option value=\"17\"> 17 <\/option>\n                <option value=\"18\"> 18 <\/option>\n                <option value=\"19\"> 19 <\/option>\n                <option value=\"20\"> 20 <\/option>\n                <option value=\"21\"> 21 <\/option>\n                <option value=\"22\"> 22 <\/option>\n                <option value=\"23\"> 23 <\/option>\n                <option value=\"24\"> 24 <\/option>\n                <option value=\"25\"> 25 <\/option>\n                <option value=\"26\"> 26 <\/option>\n                <option value=\"27\"> 27 <\/option>\n                <option value=\"28\"> 28 <\/option>\n                <option value=\"29\"> 29 <\/option>\n                <option value=\"30\"> 30 <\/option>\n                <option value=\"31\"> 31 <\/option>\n              <\/select>\n              <label class=\"form-sub-label\" for=\"input_18_day\" id=\"sublabel_day\" style=\"min-height:13px;\"> Day <\/label>\n            <\/span>\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n              <select name=\"q18_birthDate18[month]\" id=\"input_18_month\" class=\"form-dropdown validate[required]\" data-component=\"birthdate-month\">\n                <option>  <\/option>\n                <option value=\"January\"> January <\/option>\n                <option value=\"February\"> February <\/option>\n                <option value=\"March\"> March <\/option>\n                <option value=\"April\"> April <\/option>\n                <option value=\"May\"> May <\/option>\n                <option value=\"June\"> June <\/option>\n                <option value=\"July\"> July <\/option>\n                <option value=\"August\"> August <\/option>\n                <option value=\"September\"> September <\/option>\n                <option value=\"October\"> October <\/option>\n                <option value=\"November\"> November <\/option>\n                <option value=\"December\"> December <\/option>\n              <\/select>\n              <label class=\"form-sub-label\" for=\"input_18_month\" id=\"sublabel_month\" style=\"min-height:13px;\"> Month <\/label>\n            <\/span>\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n              <select name=\"q18_birthDate18[year]\" id=\"input_18_year\" class=\"form-dropdown validate[required]\" data-component=\"birthdate-year\">\n                <option>  <\/option>\n                <option value=\"2018\"> 2018 <\/option>\n                <option value=\"2017\"> 2017 <\/option>\n                <option value=\"2016\"> 2016 <\/option>\n                <option value=\"2015\"> 2015 <\/option>\n                <option value=\"2014\"> 2014 <\/option>\n                <option value=\"2013\"> 2013 <\/option>\n                <option value=\"2012\"> 2012 <\/option>\n                <option value=\"2011\"> 2011 <\/option>\n                <option value=\"2010\"> 2010 <\/option>\n                <option value=\"2009\"> 2009 <\/option>\n                <option value=\"2008\"> 2008 <\/option>\n                <option value=\"2007\"> 2007 <\/option>\n                <option value=\"2006\"> 2006 <\/option>\n                <option value=\"2005\"> 2005 <\/option>\n                <option value=\"2004\"> 2004 <\/option>\n                <option value=\"2003\"> 2003 <\/option>\n                <option value=\"2002\"> 2002 <\/option>\n                <option value=\"2001\"> 2001 <\/option>\n                <option value=\"2000\"> 2000 <\/option>\n                <option value=\"1999\"> 1999 <\/option>\n                <option value=\"1998\"> 1998 <\/option>\n                <option value=\"1997\"> 1997 <\/option>\n                <option value=\"1996\"> 1996 <\/option>\n                <option value=\"1995\"> 1995 <\/option>\n                <option value=\"1994\"> 1994 <\/option>\n                <option value=\"1993\"> 1993 <\/option>\n                <option value=\"1992\"> 1992 <\/option>\n                <option value=\"1991\"> 1991 <\/option>\n                <option value=\"1990\"> 1990 <\/option>\n                <option value=\"1989\"> 1989 <\/option>\n                <option value=\"1988\"> 1988 <\/option>\n                <option value=\"1987\"> 1987 <\/option>\n                <option value=\"1986\"> 1986 <\/option>\n                <option value=\"1985\"> 1985 <\/option>\n                <option value=\"1984\"> 1984 <\/option>\n                <option value=\"1983\"> 1983 <\/option>\n                <option value=\"1982\"> 1982 <\/option>\n                <option value=\"1981\"> 1981 <\/option>\n                <option value=\"1980\"> 1980 <\/option>\n                <option value=\"1979\"> 1979 <\/option>\n                <option value=\"1978\"> 1978 <\/option>\n                <option value=\"1977\"> 1977 <\/option>\n                <option value=\"1976\"> 1976 <\/option>\n                <option value=\"1975\"> 1975 <\/option>\n                <option value=\"1974\"> 1974 <\/option>\n                <option value=\"1973\"> 1973 <\/option>\n                <option value=\"1972\"> 1972 <\/option>\n                <option value=\"1971\"> 1971 <\/option>\n                <option value=\"1970\"> 1970 <\/option>\n                <option value=\"1969\"> 1969 <\/option>\n                <option value=\"1968\"> 1968 <\/option>\n                <option value=\"1967\"> 1967 <\/option>\n                <option value=\"1966\"> 1966 <\/option>\n                <option value=\"1965\"> 1965 <\/option>\n                <option value=\"1964\"> 1964 <\/option>\n                <option value=\"1963\"> 1963 <\/option>\n                <option value=\"1962\"> 1962 <\/option>\n                <option value=\"1961\"> 1961 <\/option>\n                <option value=\"1960\"> 1960 <\/option>\n                <option value=\"1959\"> 1959 <\/option>\n                <option value=\"1958\"> 1958 <\/option>\n                <option value=\"1957\"> 1957 <\/option>\n                <option value=\"1956\"> 1956 <\/option>\n                <option value=\"1955\"> 1955 <\/option>\n                <option value=\"1954\"> 1954 <\/option>\n                <option value=\"1953\"> 1953 <\/option>\n                <option value=\"1952\"> 1952 <\/option>\n                <option value=\"1951\"> 1951 <\/option>\n                <option value=\"1950\"> 1950 <\/option>\n                <option value=\"1949\"> 1949 <\/option>\n                <option value=\"1948\"> 1948 <\/option>\n                <option value=\"1947\"> 1947 <\/option>\n                <option value=\"1946\"> 1946 <\/option>\n                <option value=\"1945\"> 1945 <\/option>\n                <option value=\"1944\"> 1944 <\/option>\n                <option value=\"1943\"> 1943 <\/option>\n                <option value=\"1942\"> 1942 <\/option>\n                <option value=\"1941\"> 1941 <\/option>\n                <option value=\"1940\"> 1940 <\/option>\n                <option value=\"1939\"> 1939 <\/option>\n                <option value=\"1938\"> 1938 <\/option>\n                <option value=\"1937\"> 1937 <\/option>\n                <option value=\"1936\"> 1936 <\/option>\n                <option value=\"1935\"> 1935 <\/option>\n                <option value=\"1934\"> 1934 <\/option>\n                <option value=\"1933\"> 1933 <\/option>\n                <option value=\"1932\"> 1932 <\/option>\n                <option value=\"1931\"> 1931 <\/option>\n                <option value=\"1930\"> 1930 <\/option>\n                <option value=\"1929\"> 1929 <\/option>\n                <option value=\"1928\"> 1928 <\/option>\n                <option value=\"1927\"> 1927 <\/option>\n                <option value=\"1926\"> 1926 <\/option>\n                <option value=\"1925\"> 1925 <\/option>\n                <option value=\"1924\"> 1924 <\/option>\n                <option value=\"1923\"> 1923 <\/option>\n                <option value=\"1922\"> 1922 <\/option>\n                <option value=\"1921\"> 1921 <\/option>\n                <option value=\"1920\"> 1920 <\/option>\n              <\/select>\n              <label class=\"form-sub-label\" for=\"input_18_year\" id=\"sublabel_year\" style=\"min-height:13px;\"> Year <\/label>\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_email\" id=\"id_36\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_36\" for=\"input_36\">\n          E-mail\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_36\" class=\"form-input jf-required\">\n          <input type=\"email\" id=\"input_36\" name=\"q36_email36\" class=\"form-textbox validate[required, Email]\" size=\"32\" value=\"\" placeholder=\"ex: yourname@example.com\" data-component=\"email\" required=\"\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_textbox\" id=\"id_37\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_37\" for=\"input_37\">\n          Mobile Number\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_37\" class=\"form-input jf-required\">\n          <input type=\"text\" id=\"input_37\" name=\"q37_mobileNumber\" data-type=\"input-textbox\" class=\"form-textbox validate[required, Numeric]\" size=\"20\" value=\"\" maxlength=\"10\" placeholder=\"ex: 04X XXX XXXX\" data-component=\"textbox\" required=\"\" \/>\n        <\/div>\n      <\/li>\n      <li id=\"cid_53\" class=\"form-input-wide\" data-type=\"control_pagebreak\">\n        <div class=\"form-pagebreak\" data-component=\"pagebreak\">\n          <div class=\"form-pagebreak-back-container\">\n            <button id=\"form-pagebreak-back_53\" type=\"button\" class=\"form-pagebreak-back \" data-component=\"pagebreak-back\">\n              Back\n            <\/button>\n          <\/div>\n          <div class=\"form-pagebreak-next-container\">\n            <button id=\"form-pagebreak-next_53\" type=\"button\" class=\"form-pagebreak-next \" data-component=\"pagebreak-next\">\n              Next\n            <\/button>\n          <\/div>\n          <div style=\"clear:both;\" class=\"pageInfo form-sub-label\" id=\"pageInfo_53\">\n          <\/div>\n        <\/div>\n      <\/li>\n    <\/ul>\n    <ul class=\"form-section page-section\" style=\"display:none;\">\n      <li id=\"cid_58\" class=\"form-input-wide\" data-type=\"control_head\">\n        <div class=\"form-header-group \">\n          <div class=\"header-text httal htvam\">\n            <h2 id=\"header_58\" class=\"form-header\" data-component=\"header\">\n              Step 2: Your Supply &amp; Connection\n            <\/h2>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_dropdown\" id=\"id_38\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_38\" for=\"input_38\">\n          Your Supply Address\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_38\" class=\"form-input jf-required\">\n          <select class=\"form-dropdown validate[required]\" id=\"input_38\" name=\"q38_yourSupply\" style=\"width:150px;\" data-component=\"dropdown\" required=\"\">\n            <option value=\"\">  <\/option>\n            <option value=\"Unit 11\/741 Hunter Street\"> Unit 11\/741 Hunter Street <\/option>\n            <option value=\"Unit 12\/741 Hunter Street\"> Unit 12\/741 Hunter Street <\/option>\n            <option value=\"Unit 21\/741 Hunter Street\"> Unit 21\/741 Hunter Street <\/option>\n            <option value=\"Unit 22\/741 Hunter Street\"> Unit 22\/741 Hunter Street <\/option>\n            <option value=\"Unit 23\/741 Hunter Street\"> Unit 23\/741 Hunter Street <\/option>\n            <option value=\"Unit 24\/741 Hunter Street\"> Unit 24\/741 Hunter Street <\/option>\n            <option value=\"Unit 25\/741 Hunter Street\"> Unit 25\/741 Hunter Street <\/option>\n            <option value=\"Unit 26\/741 Hunter Street\"> Unit 26\/741 Hunter Street <\/option>\n            <option value=\"Unit 31\/741 Hunter Street\"> Unit 31\/741 Hunter Street <\/option>\n            <option value=\"Unit 32\/741 Hunter Street\"> Unit 32\/741 Hunter Street <\/option>\n            <option value=\"Unit 33\/741 Hunter Street\"> Unit 33\/741 Hunter Street <\/option>\n            <option value=\"Unit 34\/741 Hunter Street\"> Unit 34\/741 Hunter Street <\/option>\n            <option value=\"Unit 35\/741 Hunter Street\"> Unit 35\/741 Hunter Street <\/option>\n            <option value=\"Unit 36\/741 Hunter Street\"> Unit 36\/741 Hunter Street <\/option>\n            <option value=\"Unit 37\/741 Hunter Street\"> Unit 37\/741 Hunter Street <\/option>\n            <option value=\"Unit 41\/741 Hunter Street\"> Unit 41\/741 Hunter Street <\/option>\n            <option value=\"Unit 42\/741 Hunter Street\"> Unit 42\/741 Hunter Street <\/option>\n            <option value=\"Unit 43\/741 Hunter Street\"> Unit 43\/741 Hunter Street <\/option>\n            <option value=\"Unit 44\/741 Hunter Street\"> Unit 44\/741 Hunter Street <\/option>\n            <option value=\"Unit 45\/741 Hunter Street\"> Unit 45\/741 Hunter Street <\/option>\n            <option value=\"Unit 46\/741 Hunter Street\"> Unit 46\/741 Hunter Street <\/option>\n            <option value=\"Unit 47\/741 Hunter Street\"> Unit 47\/741 Hunter Street <\/option>\n            <option value=\"Unit 51\/741 Hunter Street\"> Unit 51\/741 Hunter Street <\/option>\n            <option value=\"Unit 52\/741 Hunter Street\"> Unit 52\/741 Hunter Street <\/option>\n            <option value=\"Unit 53\/741 Hunter Street\"> Unit 53\/741 Hunter Street <\/option>\n            <option value=\"Unit 54\/741 Hunter Street\"> Unit 54\/741 Hunter Street <\/option>\n            <option value=\"Unit 55\/741 Hunter Street\"> Unit 55\/741 Hunter Street <\/option>\n            <option value=\"Unit 56\/741 Hunter Street\"> Unit 56\/741 Hunter Street <\/option>\n            <option value=\"Unit 57\/741 Hunter Street\"> Unit 57\/741 Hunter Street <\/option>\n            <option value=\"Unit 61\/741 Hunter Street\"> Unit 61\/741 Hunter Street <\/option>\n            <option value=\"Unit 62\/741 Hunter Street\"> Unit 62\/741 Hunter Street <\/option>\n            <option value=\"Unit 63\/741 Hunter Street\"> Unit 63\/741 Hunter Street <\/option>\n            <option value=\"Unit 64\/741 Hunter Street\"> Unit 64\/741 Hunter Street <\/option>\n            <option value=\"Unit 65\/741 Hunter Street\"> Unit 65\/741 Hunter Street <\/option>\n            <option value=\"Unit 66\/741 Hunter Street\"> Unit 66\/741 Hunter Street <\/option>\n            <option value=\"Unit 67\/741 Hunter Street\"> Unit 67\/741 Hunter Street <\/option>\n            <option value=\"Unit 71\/741 Hunter Street\"> Unit 71\/741 Hunter Street <\/option>\n            <option value=\"Unit 72\/741 Hunter Street\"> Unit 72\/741 Hunter Street <\/option>\n            <option value=\"Unit 73\/741 Hunter Street\"> Unit 73\/741 Hunter Street <\/option>\n            <option value=\"Unit 74\/741 Hunter Street\"> Unit 74\/741 Hunter Street <\/option>\n            <option value=\"Unit 75\/741 Hunter Street\"> Unit 75\/741 Hunter Street <\/option>\n            <option value=\"Unit 76\/741 Hunter Street\"> Unit 76\/741 Hunter Street <\/option>\n            <option value=\"Unit 77\/741 Hunter Street\"> Unit 77\/741 Hunter Street <\/option>\n            <option value=\"Unit 81\/741 Hunter Street\"> Unit 81\/741 Hunter Street <\/option>\n            <option value=\"Unit 82\/741 Hunter Street\"> Unit 82\/741 Hunter Street <\/option>\n            <option value=\"Unit 83\/741 Hunter Street\"> Unit 83\/741 Hunter Street <\/option>\n            <option value=\"Unit 84\/741 Hunter Street\"> Unit 84\/741 Hunter Street <\/option>\n            <option value=\"Unit 85\/741 Hunter Street\"> Unit 85\/741 Hunter Street <\/option>\n            <option value=\"Unit 86\/741 Hunter Street\"> Unit 86\/741 Hunter Street <\/option>\n            <option value=\"Unit 87\/741 Hunter Street\"> Unit 87\/741 Hunter Street <\/option>\n            <option value=\"Unit 88\/741 Hunter Street\"> Unit 88\/741 Hunter Street <\/option>\n            <option value=\"Unit 91\/741 Hunter Street\"> Unit 91\/741 Hunter Street <\/option>\n            <option value=\"Unit 92\/741 Hunter Street\"> Unit 92\/741 Hunter Street <\/option>\n            <option value=\"Unit 93\/741 Hunter Street\"> Unit 93\/741 Hunter Street <\/option>\n            <option value=\"Unit 94\/741 Hunter Street\"> Unit 94\/741 Hunter Street <\/option>\n            <option value=\"Unit 95\/741 Hunter Street\"> Unit 95\/741 Hunter Street <\/option>\n            <option value=\"Unit 96\/741 Hunter Street\"> Unit 96\/741 Hunter Street <\/option>\n            <option value=\"Unit 98\/741 Hunter Street\"> Unit 98\/741 Hunter Street <\/option>\n            <option value=\"Unit 101\/741 Hunter Street\"> Unit 101\/741 Hunter Street <\/option>\n            <option value=\"Unit 102\/741 Hunter Street\"> Unit 102\/741 Hunter Street <\/option>\n            <option value=\"Unit 103\/741 Hunter Street\"> Unit 103\/741 Hunter Street <\/option>\n            <option value=\"Unit 104\/741 Hunter Street\"> Unit 104\/741 Hunter Street <\/option>\n            <option value=\"Unit 105\/741 Hunter Street\"> Unit 105\/741 Hunter Street <\/option>\n            <option value=\"Unit 106\/741 Hunter Street\"> Unit 106\/741 Hunter Street <\/option>\n            <option value=\"Unit 108\/741 Hunter Street\"> Unit 108\/741 Hunter Street <\/option>\n            <option value=\"Unit 111\/741 Hunter Street\"> Unit 111\/741 Hunter Street <\/option>\n            <option value=\"Unit 112\/741 Hunter Street\"> Unit 112\/741 Hunter Street <\/option>\n            <option value=\"Unit 113\/741 Hunter Street\"> Unit 113\/741 Hunter Street <\/option>\n            <option value=\"Unit 114\/741 Hunter Street\"> Unit 114\/741 Hunter Street <\/option>\n            <option value=\"Unit 115\/741 Hunter Street\"> Unit 115\/741 Hunter Street <\/option>\n            <option value=\"Unit 121\/741 Hunter Street\"> Unit 121\/741 Hunter Street <\/option>\n            <option value=\"Unit 122\/741 Hunter Street\"> Unit 122\/741 Hunter Street <\/option>\n            <option value=\"Unit 123\/741 Hunter Street\"> Unit 123\/741 Hunter Street <\/option>\n            <option value=\"Unit 124\/741 Hunter Street\"> Unit 124\/741 Hunter Street <\/option>\n            <option value=\"Lot 1\/741 Hunter Street\"> Lot 1\/741 Hunter Street <\/option>\n            <option value=\"Y77\/741 Hunter Street\"> Y77\/741 Hunter Street <\/option>\n            <option value=\"Y78\/741 Hunter Street\"> Y78\/741 Hunter Street <\/option>\n          <\/select>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_datetime\" id=\"id_51\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_51\" for=\"day_51\">\n          Connection Date\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_51\" class=\"form-input jf-required\">\n          <div data-wrapper-react=\"true\">\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n              <input class=\"form-textbox validate[required, limitDate]\" id=\"day_51\" name=\"q51_connectionDate[day]\" type=\"tel\" size=\"2\" data-maxlength=\"2\" value=\"\" required=\"\" \/>\n              <span class=\"date-separate\">\n                \u00a0-\n              <\/span>\n              <label class=\"form-sub-label\" for=\"day_51\" id=\"sublabel_day\" style=\"min-height:13px;\"> Day <\/label>\n            <\/span>\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n              <input class=\"form-textbox validate[required, limitDate]\" id=\"month_51\" name=\"q51_connectionDate[month]\" type=\"tel\" size=\"2\" data-maxlength=\"2\" value=\"\" required=\"\" \/>\n              <span class=\"date-separate\">\n                \u00a0-\n              <\/span>\n              <label class=\"form-sub-label\" for=\"month_51\" id=\"sublabel_month\" style=\"min-height:13px;\"> Month <\/label>\n            <\/span>\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n              <input class=\"form-textbox validate[required, limitDate]\" id=\"year_51\" name=\"q51_connectionDate[year]\" type=\"tel\" size=\"4\" data-maxlength=\"4\" value=\"\" required=\"\" \/>\n              <label class=\"form-sub-label\" for=\"year_51\" id=\"sublabel_year\" style=\"min-height:13px;\"> Year <\/label>\n            <\/span>\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n              <img class=\"showAutoCalendar\" alt=\"Pick a Date\" id=\"input_51_pick\" src=\"https:\/\/cdn.jotfor.ms\/images\/calendar.png\" style=\"vertical-align:middle;\" data-component=\"datetime\" \/>\n              <label class=\"form-sub-label\" for=\"input_51_pick\" style=\"min-height:13px;\">  <\/label>\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_checkbox\" id=\"id_41\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_41\" for=\"input_41_0\"> Your Product Choice <\/label>\n        <div id=\"cid_41\" class=\"form-input\">\n          <div class=\"form-single-column\" data-component=\"checkbox\">\n            <span class=\"form-checkbox-item\" style=\"clear:left;\">\n              <span class=\"dragger-item\">\n              <\/span>\n              <input type=\"checkbox\" class=\"form-checkbox validate[maxselection,minselection]\" id=\"input_41_0\" name=\"q41_yourProduct[]\" value=\"Energy and Thermal Services\" data-maxselection=\"1\" data-minselection=\"1\" \/>\n              <label id=\"label_input_41_0\" for=\"input_41_0\"> Energy and Thermal Services <\/label>\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_text\" id=\"id_83\">\n        <div id=\"cid_83\" class=\"form-input-wide\">\n          <div id=\"text_83\" class=\"form-html\" data-component=\"text\">\n            <p>Energy Services for The Pinnacle include Electricity and Hot Water.<\/p>\n            <p>If you would like Network And Thermal Services only please contact our Customer Support team on 1300 803 803<\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li id=\"cid_54\" class=\"form-input-wide\" data-type=\"control_pagebreak\">\n        <div class=\"form-pagebreak\" data-component=\"pagebreak\">\n          <div class=\"form-pagebreak-back-container\">\n            <button id=\"form-pagebreak-back_54\" type=\"button\" class=\"form-pagebreak-back \" data-component=\"pagebreak-back\">\n              Back\n            <\/button>\n          <\/div>\n          <div class=\"form-pagebreak-next-container\">\n            <button id=\"form-pagebreak-next_54\" type=\"button\" class=\"form-pagebreak-next \" data-component=\"pagebreak-next\">\n              Next\n            <\/button>\n          <\/div>\n          <div style=\"clear:both;\" class=\"pageInfo form-sub-label\" id=\"pageInfo_54\">\n          <\/div>\n        <\/div>\n      <\/li>\n    <\/ul>\n    <ul class=\"form-section page-section\" style=\"display:none;\">\n      <li id=\"cid_60\" class=\"form-input-wide\" data-type=\"control_head\">\n        <div class=\"form-header-group \">\n          <div class=\"header-text httal htvam\">\n            <h2 id=\"header_60\" class=\"form-header\" data-component=\"header\">\n              Step 3: Your Billing Details\n            <\/h2>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_text\" id=\"id_63\">\n        <div id=\"cid_63\" class=\"form-input-wide\">\n          <div id=\"text_63\" class=\"form-html\" data-component=\"text\">\n            <p>The supply address is your default billing address. You can provide another address here if you like<\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_address\" id=\"id_12\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_12\" for=\"input_12_addr_line1\"> Billing Address <\/label>\n        <div id=\"cid_12\" class=\"form-input\">\n          <table summary=\"\" class=\"form-address-table\" cellpadding=\"0\" cellspacing=\"0\">\n            <tbody>\n              <tr>\n                <td colspan=\"2\">\n                  <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n                    <input type=\"text\" id=\"input_12_addr_line1\" name=\"q12_billingAddress[addr_line1]\" class=\"form-textbox form-address-line\" value=\"\" data-component=\"address_line_1\" \/>\n                    <label class=\"form-sub-label\" for=\"input_12_addr_line1\" id=\"sublabel_12_addr_line1\" style=\"min-height:13px;\"> Street Address <\/label>\n                  <\/span>\n                <\/td>\n              <\/tr>\n              <tr>\n                <td colspan=\"2\">\n                  <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n                    <input type=\"text\" id=\"input_12_addr_line2\" name=\"q12_billingAddress[addr_line2]\" class=\"form-textbox form-address-line\" size=\"46\" value=\"\" data-component=\"address_line_2\" \/>\n                    <label class=\"form-sub-label\" for=\"input_12_addr_line2\" id=\"sublabel_12_addr_line2\" style=\"min-height:13px;\"> Street Address Line 2 <\/label>\n                  <\/span>\n                <\/td>\n              <\/tr>\n              <tr>\n                <td width=\"50%\">\n                  <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n                    <input type=\"text\" id=\"input_12_city\" name=\"q12_billingAddress[city]\" class=\"form-textbox form-address-city\" size=\"21\" value=\"\" data-component=\"city\" \/>\n                    <label class=\"form-sub-label\" for=\"input_12_city\" id=\"sublabel_12_city\" style=\"min-height:13px;\"> City <\/label>\n                  <\/span>\n                <\/td>\n                <td>\n                  <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n                    <input type=\"text\" id=\"input_12_state\" name=\"q12_billingAddress[state]\" class=\"form-textbox form-address-state\" size=\"22\" value=\"\" data-component=\"state\" \/>\n                    <label class=\"form-sub-label\" for=\"input_12_state\" id=\"sublabel_12_state\" style=\"min-height:13px;\"> State \/ Province <\/label>\n                  <\/span>\n                <\/td>\n              <\/tr>\n              <tr>\n                <td width=\"50%\">\n                  <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n                    <input type=\"text\" id=\"input_12_postal\" name=\"q12_billingAddress[postal]\" class=\"form-textbox form-address-postal\" size=\"10\" value=\"\" data-component=\"zip\" \/>\n                    <label class=\"form-sub-label\" for=\"input_12_postal\" id=\"sublabel_12_postal\" style=\"min-height:13px;\"> Postal \/ Zip Code <\/label>\n                  <\/span>\n                <\/td>\n                <td>\n                  <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n                    <select class=\"form-dropdown form-address-country\" name=\"q12_billingAddress[country]\" id=\"input_12_country\" data-component=\"country\">\n                      <option value=\"\"> Please Select <\/option>\n                      <option value=\"United States\"> United States <\/option>\n                      <option value=\"Afghanistan\"> Afghanistan <\/option>\n                      <option value=\"Albania\"> Albania <\/option>\n                      <option value=\"Algeria\"> Algeria <\/option>\n                      <option value=\"American Samoa\"> American Samoa <\/option>\n                      <option value=\"Andorra\"> Andorra <\/option>\n                      <option value=\"Angola\"> Angola <\/option>\n                      <option value=\"Anguilla\"> Anguilla <\/option>\n                      <option value=\"Antigua and Barbuda\"> Antigua and Barbuda <\/option>\n                      <option value=\"Argentina\"> Argentina <\/option>\n                      <option value=\"Armenia\"> Armenia <\/option>\n                      <option value=\"Aruba\"> Aruba <\/option>\n                      <option value=\"Australia\"> Australia <\/option>\n                      <option value=\"Austria\"> Austria <\/option>\n                      <option value=\"Azerbaijan\"> Azerbaijan <\/option>\n                      <option value=\"The Bahamas\"> The Bahamas <\/option>\n                      <option value=\"Bahrain\"> Bahrain <\/option>\n                      <option value=\"Bangladesh\"> Bangladesh <\/option>\n                      <option value=\"Barbados\"> Barbados <\/option>\n                      <option value=\"Belarus\"> Belarus <\/option>\n                      <option value=\"Belgium\"> Belgium <\/option>\n                      <option value=\"Belize\"> Belize <\/option>\n                      <option value=\"Benin\"> Benin <\/option>\n                      <option value=\"Bermuda\"> Bermuda <\/option>\n                      <option value=\"Bhutan\"> Bhutan <\/option>\n                      <option value=\"Bolivia\"> Bolivia <\/option>\n                      <option value=\"Bosnia and Herzegovina\"> Bosnia and Herzegovina <\/option>\n                      <option value=\"Botswana\"> Botswana <\/option>\n                      <option value=\"Brazil\"> Brazil <\/option>\n                      <option value=\"Brunei\"> Brunei <\/option>\n                      <option value=\"Bulgaria\"> Bulgaria <\/option>\n                      <option value=\"Burkina Faso\"> Burkina Faso <\/option>\n                      <option value=\"Burundi\"> Burundi <\/option>\n                      <option value=\"Cambodia\"> Cambodia <\/option>\n                      <option value=\"Cameroon\"> Cameroon <\/option>\n                      <option value=\"Canada\"> Canada <\/option>\n                      <option value=\"Cape Verde\"> Cape Verde <\/option>\n                      <option value=\"Cayman Islands\"> Cayman Islands <\/option>\n                      <option value=\"Central African Republic\"> Central African Republic <\/option>\n                      <option value=\"Chad\"> Chad <\/option>\n                      <option value=\"Chile\"> Chile <\/option>\n                      <option value=\"China\"> China <\/option>\n                      <option value=\"Christmas Island\"> Christmas Island <\/option>\n                      <option value=\"Cocos (Keeling) Islands\"> Cocos (Keeling) Islands <\/option>\n                      <option value=\"Colombia\"> Colombia <\/option>\n                      <option value=\"Comoros\"> Comoros <\/option>\n                      <option value=\"Congo\"> Congo <\/option>\n                      <option value=\"Cook Islands\"> Cook Islands <\/option>\n                      <option value=\"Costa Rica\"> Costa Rica <\/option>\n                      <option value=\"Cote d&#x27;Ivoire\"> Cote d&#x27;Ivoire <\/option>\n                      <option value=\"Croatia\"> Croatia <\/option>\n                      <option value=\"Cuba\"> Cuba <\/option>\n                      <option value=\"Cyprus\"> Cyprus <\/option>\n                      <option value=\"Czech Republic\"> Czech Republic <\/option>\n                      <option value=\"Democratic Republic of the Congo\"> Democratic Republic of the Congo <\/option>\n                      <option value=\"Denmark\"> Denmark <\/option>\n                      <option value=\"Djibouti\"> Djibouti <\/option>\n                      <option value=\"Dominica\"> Dominica <\/option>\n                      <option value=\"Dominican Republic\"> Dominican Republic <\/option>\n                      <option value=\"Ecuador\"> Ecuador <\/option>\n                      <option value=\"Egypt\"> Egypt <\/option>\n                      <option value=\"El Salvador\"> El Salvador <\/option>\n                      <option value=\"Equatorial Guinea\"> Equatorial Guinea <\/option>\n                      <option value=\"Eritrea\"> Eritrea <\/option>\n                      <option value=\"Estonia\"> Estonia <\/option>\n                      <option value=\"Ethiopia\"> Ethiopia <\/option>\n                      <option value=\"Falkland Islands\"> Falkland Islands <\/option>\n                      <option value=\"Faroe Islands\"> Faroe Islands <\/option>\n                      <option value=\"Fiji\"> Fiji <\/option>\n                      <option value=\"Finland\"> Finland <\/option>\n                      <option value=\"France\"> France <\/option>\n                      <option value=\"French Polynesia\"> French Polynesia <\/option>\n                      <option value=\"Gabon\"> Gabon <\/option>\n                      <option value=\"The Gambia\"> The Gambia <\/option>\n                      <option value=\"Georgia\"> Georgia <\/option>\n                      <option value=\"Germany\"> Germany <\/option>\n                      <option value=\"Ghana\"> Ghana <\/option>\n                      <option value=\"Gibraltar\"> Gibraltar <\/option>\n                      <option value=\"Greece\"> Greece <\/option>\n                      <option value=\"Greenland\"> Greenland <\/option>\n                      <option value=\"Grenada\"> Grenada <\/option>\n                      <option value=\"Guadeloupe\"> Guadeloupe <\/option>\n                      <option value=\"Guam\"> Guam <\/option>\n                      <option value=\"Guatemala\"> Guatemala <\/option>\n                      <option value=\"Guernsey\"> Guernsey <\/option>\n                      <option value=\"Guinea\"> Guinea <\/option>\n                      <option value=\"Guinea-Bissau\"> Guinea-Bissau <\/option>\n                      <option value=\"Guyana\"> Guyana <\/option>\n                      <option value=\"Haiti\"> Haiti <\/option>\n                      <option value=\"Honduras\"> Honduras <\/option>\n                      <option value=\"Hong Kong\"> Hong Kong <\/option>\n                      <option value=\"Hungary\"> Hungary <\/option>\n                      <option value=\"Iceland\"> Iceland <\/option>\n                      <option value=\"India\"> India <\/option>\n                      <option value=\"Indonesia\"> Indonesia <\/option>\n                      <option value=\"Iran\"> Iran <\/option>\n                      <option value=\"Iraq\"> Iraq <\/option>\n                      <option value=\"Ireland\"> Ireland <\/option>\n                      <option value=\"Israel\"> Israel <\/option>\n                      <option value=\"Italy\"> Italy <\/option>\n                      <option value=\"Jamaica\"> Jamaica <\/option>\n                      <option value=\"Japan\"> Japan <\/option>\n                      <option value=\"Jersey\"> Jersey <\/option>\n                      <option value=\"Jordan\"> Jordan <\/option>\n                      <option value=\"Kazakhstan\"> Kazakhstan <\/option>\n                      <option value=\"Kenya\"> Kenya <\/option>\n                      <option value=\"Kiribati\"> Kiribati <\/option>\n                      <option value=\"North Korea\"> North Korea <\/option>\n                      <option value=\"South Korea\"> South Korea <\/option>\n                      <option value=\"Kosovo\"> Kosovo <\/option>\n                      <option value=\"Kuwait\"> Kuwait <\/option>\n                      <option value=\"Kyrgyzstan\"> Kyrgyzstan <\/option>\n                      <option value=\"Laos\"> Laos <\/option>\n                      <option value=\"Latvia\"> Latvia <\/option>\n                      <option value=\"Lebanon\"> Lebanon <\/option>\n                      <option value=\"Lesotho\"> Lesotho <\/option>\n                      <option value=\"Liberia\"> Liberia <\/option>\n                      <option value=\"Libya\"> Libya <\/option>\n                      <option value=\"Liechtenstein\"> Liechtenstein <\/option>\n                      <option value=\"Lithuania\"> Lithuania <\/option>\n                      <option value=\"Luxembourg\"> Luxembourg <\/option>\n                      <option value=\"Macau\"> Macau <\/option>\n                      <option value=\"Macedonia\"> Macedonia <\/option>\n                      <option value=\"Madagascar\"> Madagascar <\/option>\n                      <option value=\"Malawi\"> Malawi <\/option>\n                      <option value=\"Malaysia\"> Malaysia <\/option>\n                      <option value=\"Maldives\"> Maldives <\/option>\n                      <option value=\"Mali\"> Mali <\/option>\n                      <option value=\"Malta\"> Malta <\/option>\n                      <option value=\"Marshall Islands\"> Marshall Islands <\/option>\n                      <option value=\"Martinique\"> Martinique <\/option>\n                      <option value=\"Mauritania\"> Mauritania <\/option>\n                      <option value=\"Mauritius\"> Mauritius <\/option>\n                      <option value=\"Mayotte\"> Mayotte <\/option>\n                      <option value=\"Mexico\"> Mexico <\/option>\n                      <option value=\"Micronesia\"> Micronesia <\/option>\n                      <option value=\"Moldova\"> Moldova <\/option>\n                      <option value=\"Monaco\"> Monaco <\/option>\n                      <option value=\"Mongolia\"> Mongolia <\/option>\n                      <option value=\"Montenegro\"> Montenegro <\/option>\n                      <option value=\"Montserrat\"> Montserrat <\/option>\n                      <option value=\"Morocco\"> Morocco <\/option>\n                      <option value=\"Mozambique\"> Mozambique <\/option>\n                      <option value=\"Myanmar\"> Myanmar <\/option>\n                      <option value=\"Nagorno-Karabakh\"> Nagorno-Karabakh <\/option>\n                      <option value=\"Namibia\"> Namibia <\/option>\n                      <option value=\"Nauru\"> Nauru <\/option>\n                      <option value=\"Nepal\"> Nepal <\/option>\n                      <option value=\"Netherlands\"> Netherlands <\/option>\n                      <option value=\"Netherlands Antilles\"> Netherlands Antilles <\/option>\n                      <option value=\"New Caledonia\"> New Caledonia <\/option>\n                      <option value=\"New Zealand\"> New Zealand <\/option>\n                      <option value=\"Nicaragua\"> Nicaragua <\/option>\n                      <option value=\"Niger\"> Niger <\/option>\n                      <option value=\"Nigeria\"> Nigeria <\/option>\n                      <option value=\"Niue\"> Niue <\/option>\n                      <option value=\"Norfolk Island\"> Norfolk Island <\/option>\n                      <option value=\"Turkish Republic of Northern Cyprus\"> Turkish Republic of Northern Cyprus <\/option>\n                      <option value=\"Northern Mariana\"> Northern Mariana <\/option>\n                      <option value=\"Norway\"> Norway <\/option>\n                      <option value=\"Oman\"> Oman <\/option>\n                      <option value=\"Pakistan\"> Pakistan <\/option>\n                      <option value=\"Palau\"> Palau <\/option>\n                      <option value=\"Palestine\"> Palestine <\/option>\n                      <option value=\"Panama\"> Panama <\/option>\n                      <option value=\"Papua New Guinea\"> Papua New Guinea <\/option>\n                      <option value=\"Paraguay\"> Paraguay <\/option>\n                      <option value=\"Peru\"> Peru <\/option>\n                      <option value=\"Philippines\"> Philippines <\/option>\n                      <option value=\"Pitcairn Islands\"> Pitcairn Islands <\/option>\n                      <option value=\"Poland\"> Poland <\/option>\n                      <option value=\"Portugal\"> Portugal <\/option>\n                      <option value=\"Puerto Rico\"> Puerto Rico <\/option>\n                      <option value=\"Qatar\"> Qatar <\/option>\n                      <option value=\"Republic of the Congo\"> Republic of the Congo <\/option>\n                      <option value=\"Romania\"> Romania <\/option>\n                      <option value=\"Russia\"> Russia <\/option>\n                      <option value=\"Rwanda\"> Rwanda <\/option>\n                      <option value=\"Saint Barthelemy\"> Saint Barthelemy <\/option>\n                      <option value=\"Saint Helena\"> Saint Helena <\/option>\n                      <option value=\"Saint Kitts and Nevis\"> Saint Kitts and Nevis <\/option>\n                      <option value=\"Saint Lucia\"> Saint Lucia <\/option>\n                      <option value=\"Saint Martin\"> Saint Martin <\/option>\n                      <option value=\"Saint Pierre and Miquelon\"> Saint Pierre and Miquelon <\/option>\n                      <option value=\"Saint Vincent and the Grenadines\"> Saint Vincent and the Grenadines <\/option>\n                      <option value=\"Samoa\"> Samoa <\/option>\n                      <option value=\"San Marino\"> San Marino <\/option>\n                      <option value=\"Sao Tome and Principe\"> Sao Tome and Principe <\/option>\n                      <option value=\"Saudi Arabia\"> Saudi Arabia <\/option>\n                      <option value=\"Senegal\"> Senegal <\/option>\n                      <option value=\"Serbia\"> Serbia <\/option>\n                      <option value=\"Seychelles\"> Seychelles <\/option>\n                      <option value=\"Sierra Leone\"> Sierra Leone <\/option>\n                      <option value=\"Singapore\"> Singapore <\/option>\n                      <option value=\"Slovakia\"> Slovakia <\/option>\n                      <option value=\"Slovenia\"> Slovenia <\/option>\n                      <option value=\"Solomon Islands\"> Solomon Islands <\/option>\n                      <option value=\"Somalia\"> Somalia <\/option>\n                      <option value=\"Somaliland\"> Somaliland <\/option>\n                      <option value=\"South Africa\"> South Africa <\/option>\n                      <option value=\"South Ossetia\"> South Ossetia <\/option>\n                      <option value=\"South Sudan\"> South Sudan <\/option>\n                      <option value=\"Spain\"> Spain <\/option>\n                      <option value=\"Sri Lanka\"> Sri Lanka <\/option>\n                      <option value=\"Sudan\"> Sudan <\/option>\n                      <option value=\"Suriname\"> Suriname <\/option>\n                      <option value=\"Svalbard\"> Svalbard <\/option>\n                      <option value=\"Swaziland\"> Swaziland <\/option>\n                      <option value=\"Sweden\"> Sweden <\/option>\n                      <option value=\"Switzerland\"> Switzerland <\/option>\n                      <option value=\"Syria\"> Syria <\/option>\n                      <option value=\"Taiwan\"> Taiwan <\/option>\n                      <option value=\"Tajikistan\"> Tajikistan <\/option>\n                      <option value=\"Tanzania\"> Tanzania <\/option>\n                      <option value=\"Thailand\"> Thailand <\/option>\n                      <option value=\"Timor-Leste\"> Timor-Leste <\/option>\n                      <option value=\"Togo\"> Togo <\/option>\n                      <option value=\"Tokelau\"> Tokelau <\/option>\n                      <option value=\"Tonga\"> Tonga <\/option>\n                      <option value=\"Transnistria Pridnestrovie\"> Transnistria Pridnestrovie <\/option>\n                      <option value=\"Trinidad and Tobago\"> Trinidad and Tobago <\/option>\n                      <option value=\"Tristan da Cunha\"> Tristan da Cunha <\/option>\n                      <option value=\"Tunisia\"> Tunisia <\/option>\n                      <option value=\"Turkey\"> Turkey <\/option>\n                      <option value=\"Turkmenistan\"> Turkmenistan <\/option>\n                      <option value=\"Turks and Caicos Islands\"> Turks and Caicos Islands <\/option>\n                      <option value=\"Tuvalu\"> Tuvalu <\/option>\n                      <option value=\"Uganda\"> Uganda <\/option>\n                      <option value=\"Ukraine\"> Ukraine <\/option>\n                      <option value=\"United Arab Emirates\"> United Arab Emirates <\/option>\n                      <option value=\"United Kingdom\"> United Kingdom <\/option>\n                      <option value=\"Uruguay\"> Uruguay <\/option>\n                      <option value=\"Uzbekistan\"> Uzbekistan <\/option>\n                      <option value=\"Vanuatu\"> Vanuatu <\/option>\n                      <option value=\"Vatican City\"> Vatican City <\/option>\n                      <option value=\"Venezuela\"> Venezuela <\/option>\n                      <option value=\"Vietnam\"> Vietnam <\/option>\n                      <option value=\"British Virgin Islands\"> British Virgin Islands <\/option>\n                      <option value=\"Isle of Man\"> Isle of Man <\/option>\n                      <option value=\"US Virgin Islands\"> US Virgin Islands <\/option>\n                      <option value=\"Wallis and Futuna\"> Wallis and Futuna <\/option>\n                      <option value=\"Western Sahara\"> Western Sahara <\/option>\n                      <option value=\"Yemen\"> Yemen <\/option>\n                      <option value=\"Zambia\"> Zambia <\/option>\n                      <option value=\"Zimbabwe\"> Zimbabwe <\/option>\n                      <option value=\"other\"> Other <\/option>\n                    <\/select>\n                    <label class=\"form-sub-label\" for=\"input_12_country\" id=\"sublabel_12_country\" style=\"min-height:13px;\"> Country <\/label>\n                  <\/span>\n                <\/td>\n              <\/tr>\n            <\/tbody>\n          <\/table>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_checkbox\" id=\"id_65\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_65\" for=\"input_65_0\"> Paperless Billing <\/label>\n        <div id=\"cid_65\" class=\"form-input\">\n          <div class=\"form-single-column\" data-component=\"checkbox\">\n            <span class=\"form-checkbox-item\" style=\"clear:left;\">\n              <span class=\"dragger-item\">\n              <\/span>\n              <input type=\"checkbox\" class=\"form-checkbox\" id=\"input_65_0\" name=\"q65_paperlessBilling[]\" checked=\"\" value=\"E-Bill\" \/>\n              <label id=\"label_input_65_0\" for=\"input_65_0\"> E-Bill <\/label>\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li id=\"cid_55\" class=\"form-input-wide\" data-type=\"control_pagebreak\">\n        <div class=\"form-pagebreak\" data-component=\"pagebreak\">\n          <div class=\"form-pagebreak-back-container\">\n            <button id=\"form-pagebreak-back_55\" type=\"button\" class=\"form-pagebreak-back \" data-component=\"pagebreak-back\">\n              Back\n            <\/button>\n          <\/div>\n          <div class=\"form-pagebreak-next-container\">\n            <button id=\"form-pagebreak-next_55\" type=\"button\" class=\"form-pagebreak-next \" data-component=\"pagebreak-next\">\n              Next\n            <\/button>\n          <\/div>\n          <div style=\"clear:both;\" class=\"pageInfo form-sub-label\" id=\"pageInfo_55\">\n          <\/div>\n        <\/div>\n      <\/li>\n    <\/ul>\n    <ul class=\"form-section page-section\" style=\"display:none;\">\n      <li id=\"cid_62\" class=\"form-input-wide\" data-type=\"control_head\">\n        <div class=\"form-header-group \">\n          <div class=\"header-text httal htvam\">\n            <h2 id=\"header_62\" class=\"form-header\" data-component=\"header\">\n              Step 4: Life Support &amp; Medical Cooling\n            <\/h2>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_text\" id=\"id_67\">\n        <div id=\"cid_67\" class=\"form-input-wide\">\n          <div id=\"text_67\" class=\"form-html\" data-component=\"text\">\n            <p>Please tell us if you have any life support or medical cooling equipment at your supply address. If you do, we will inform the local area distributor so that they can prioritise your energy reconnection in the event of a power outage. Please note that we are required to verify your use of life support equipment.<\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_checkbox\" id=\"id_44\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_44\" for=\"input_44_0\"> Do you use Life Support or Medical Cooling equipment? <\/label>\n        <div id=\"cid_44\" class=\"form-input\">\n          <div class=\"form-single-column\" data-component=\"checkbox\">\n            <span class=\"form-checkbox-item\" style=\"clear:left;\">\n              <span class=\"dragger-item\">\n              <\/span>\n              <input type=\"checkbox\" class=\"form-checkbox\" id=\"input_44_0\" name=\"q44_doYou[]\" value=\"Life Support\" \/>\n              <label id=\"label_input_44_0\" for=\"input_44_0\"> Life Support <\/label>\n            <\/span>\n            <span class=\"form-checkbox-item\" style=\"clear:left;\">\n              <span class=\"dragger-item\">\n              <\/span>\n              <input type=\"checkbox\" class=\"form-checkbox\" id=\"input_44_1\" name=\"q44_doYou[]\" value=\"Medical Cooling\" \/>\n              <label id=\"label_input_44_1\" for=\"input_44_1\"> Medical Cooling <\/label>\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_textarea\" id=\"id_68\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_68\" for=\"input_68\"> You can provide further details here if needed <\/label>\n        <div id=\"cid_68\" class=\"form-input\">\n          <textarea id=\"input_68\" class=\"form-textarea\" name=\"q68_youCan\" cols=\"40\" rows=\"6\" data-component=\"textarea\"><\/textarea>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_text\" id=\"id_82\">\n        <div id=\"cid_82\" class=\"form-input-wide\">\n          <div id=\"text_82\" class=\"form-html\" data-component=\"text\">\n            <p>NSW Life Support Rebate <a href=\"http:\/\/www.resourcesandenergy.nsw.gov.au\/__data\/assets\/pdf_file\/0020\/300755\/LSR-Direct-Retail-Customers.pdf\" target=\"_blank\">APPLICATION FORM<\/a>.<\/p>\n            <p>Please complete the application and send a scanned copy back to Flow.<\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_fileupload\" id=\"id_66\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_66\" for=\"input_66\"> Attatch Supporting Evidence <\/label>\n        <div id=\"cid_66\" class=\"form-input\">\n          <input type=\"file\" id=\"input_66\" name=\"q66_attatchSupporting66\" class=\"form-upload\" data-imagevalidate=\"yes\" data-file-accept=\"pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zip, mp3, wma, mpg, flv, avi, jpg, jpeg, png, gif\" data-file-maxsize=\"1024\" data-file-minsize=\"0\" data-file-limit=\"0\" data-component=\"fileupload\" \/>\n        <\/div>\n      <\/li>\n      <li id=\"cid_56\" class=\"form-input-wide\" data-type=\"control_pagebreak\">\n        <div class=\"form-pagebreak\" data-component=\"pagebreak\">\n          <div class=\"form-pagebreak-back-container\">\n            <button id=\"form-pagebreak-back_56\" type=\"button\" class=\"form-pagebreak-back \" data-component=\"pagebreak-back\">\n              Back\n            <\/button>\n          <\/div>\n          <div class=\"form-pagebreak-next-container\">\n            <button id=\"form-pagebreak-next_56\" type=\"button\" class=\"form-pagebreak-next \" data-component=\"pagebreak-next\">\n              Next\n            <\/button>\n          <\/div>\n          <div style=\"clear:both;\" class=\"pageInfo form-sub-label\" id=\"pageInfo_56\">\n          <\/div>\n        <\/div>\n      <\/li>\n    <\/ul>\n    <ul class=\"form-section page-section\" style=\"display:none;\">\n      <li id=\"cid_69\" class=\"form-input-wide\" data-type=\"control_head\">\n        <div class=\"form-header-group \">\n          <div class=\"header-text httal htvam\">\n            <h2 id=\"header_69\" class=\"form-header\" data-component=\"header\">\n              Step 5: Your Agreement &amp; Understanding\n            <\/h2>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_text\" id=\"id_71\">\n        <div id=\"cid_71\" class=\"form-input-wide\">\n          <div id=\"text_71\" class=\"form-html\" data-component=\"text\">\n            <p>We require your explicit and informed consent to proceed. Please read our terms and conditions before proceeding.<\/p>\n            <p>Important notice to customer: You have the right to cancel your new energy contract within 10 business days from the day you receive your Welcome Pack from us. Details about your rights to cancel the contract are set out in the Welcome Pack you will receive.<\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_checkbox\" id=\"id_81\">\n        <label class=\"form-label form-label-top\" id=\"label_81\" for=\"input_81_0\">\n          Explicit Informed Consent\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_81\" class=\"form-input-wide jf-required\">\n          <div class=\"form-single-column\" data-component=\"checkbox\">\n            <span class=\"form-checkbox-item\" style=\"clear:left;\">\n              <span class=\"dragger-item\">\n              <\/span>\n              <input type=\"checkbox\" class=\"form-checkbox validate[required, maxselection,minselection]\" id=\"input_81_0\" name=\"q81_explicitInformed[]\" value=\"I understand that I am choosing to buy electricity\/network services from Strata Plan 80412 (Seller)\" required=\"\" data-maxselection=\"4\" data-minselection=\"3\" \/>\n              <label id=\"label_input_81_0\" for=\"input_81_0\"> I understand that I am choosing to buy electricity\/network services from Strata Plan 80412 (Seller) <\/label>\n            <\/span>\n            <span class=\"form-checkbox-item\" style=\"clear:left;\">\n              <span class=\"dragger-item\">\n              <\/span>\n              <input type=\"checkbox\" class=\"form-checkbox validate[required, maxselection,minselection]\" id=\"input_81_1\" name=\"q81_explicitInformed[]\" value=\"I will allow [the Seller and Flow Systems Pty Ltd (as the Seller\u2019s appointed billing and customer service agent) to collect, use and disclose my personal information\" required=\"\" data-maxselection=\"4\" data-minselection=\"3\" \/>\n              <label id=\"label_input_81_1\" for=\"input_81_1\"> I will allow [the Seller and Flow Systems Pty Ltd (as the Seller\u2019s appointed billing and customer service agent) to collect, use and disclose my personal information <\/label>\n            <\/span>\n            <span class=\"form-checkbox-item\" style=\"clear:left;\">\n              <span class=\"dragger-item\">\n              <\/span>\n              <input type=\"checkbox\" class=\"form-checkbox validate[required, maxselection,minselection]\" id=\"input_81_2\" name=\"q81_explicitInformed[]\" value=\"I have read, understood and agreed to the Terms\" required=\"\" data-maxselection=\"4\" data-minselection=\"3\" \/>\n              <label id=\"label_input_81_2\" for=\"input_81_2\"> I have read, understood and agreed to the Terms <\/label>\n            <\/span>\n            <span class=\"form-checkbox-item\" style=\"clear:left;\">\n              <span class=\"dragger-item\">\n              <\/span>\n              <input type=\"checkbox\" class=\"form-checkbox validate[required, maxselection,minselection]\" id=\"input_81_3\" name=\"q81_explicitInformed[]\" value=\"I also consent to Flow sending me general communications by SMS unless I otherwise advise\" required=\"\" data-maxselection=\"4\" data-minselection=\"3\" \/>\n              <label id=\"label_input_81_3\" for=\"input_81_3\"> I also consent to Flow sending me general communications by SMS unless I otherwise advise <\/label>\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_button\" id=\"id_9\">\n        <div id=\"cid_9\" class=\"form-input-wide\">\n          <div style=\"text-align:right;\" class=\"form-buttons-wrapper\">\n            <button id=\"input_9\" type=\"submit\" class=\"form-submit-button\" data-component=\"button\">\n              Open Account\n            <\/button>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li style=\"display:none\">\n        Should be Empty:\n        <input type=\"text\" name=\"website\" value=\"\" \/>\n      <\/li>\n    <\/ul>\n  <\/div>\n  <script>\n  JotForm.showJotFormPowered = \"0\";\n  <\/script>\n  <input type=\"hidden\" id=\"simple_spc\" name=\"simple_spc\" value=\"51527874868876\" \/>\n  <script type=\"text\/javascript\">\n  document.getElementById(\"si\" + \"mple\" + \"_spc\").value = \"51527874868876-51527874868876\";\n  <\/script>\n<\/form><\/body>\n<\/html>\n","Pinnacle Apartments Energy: Open Account",Array,0);(function(){window.handleIFrameMessage=function(e){if(!e.data||!e.data.split)return;var args=e.data.split(":");var iframe=document.getElementById("51527874868876");if(!iframe){return};switch(args[0]){case"scrollIntoView":if(!("nojump"in FrameBuilder.get)){iframe.scrollIntoView();}
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