var qsProxy = {};
function FrameBuilder(formId,appendTo,initialHeight,iframeCode,title,embedStyleJSON,isSmartEmbedEnabled){this.formId=formId;this.initialHeight=initialHeight;this.iframeCode=iframeCode;this.frame=null;this.timeInterval=200;this.appendTo=appendTo||false;this.formSubmitted=0;this.frameMinWidth='100%';this.defaultHeight='';this.isSmartEmbedEnabled=isSmartEmbedEnabled===1;this.init=function(){this.embedURLHash=this.getMD5(window.location.href);if(embedStyleJSON&&(embedStyleJSON[this.embedURLHash]&&embedStyleJSON[this.embedURLHash]['inlineStyle']['embedWidth'])){this.frameMinWidth=embedStyleJSON[this.embedURLHash]['inlineStyle']['embedWidth']+'px';}
if(embedStyleJSON&&(embedStyleJSON[this.embedURLHash])){if(embedStyleJSON[this.embedURLHash]['inlineStyle']&&embedStyleJSON[this.embedURLHash]['inlineStyle']['embedHeight']){this.defaultHeight='data-frameHeight="'+embedStyleJSON[this.embedURLHash]['inlineStyle']['embedHeight']+'"';}}
this.createFrame();this.addFrameContent(this.iframeCode);};this.createFrame=function(){var tmp_is_ie=!!window.ActiveXObject;this.iframeDomId=document.getElementById(this.formId)?this.formId+'_'+new Date().getTime():this.formId;var htmlCode="<"+"iframe title=\""+title.replace(/[\\"']/g,'\\$&').replace(/&amp;/g,'&')+"\" src=\"\" allowtransparency=\"true\" allowfullscreen=\"true\" name=\""+this.formId+"\" id=\""+this.iframeDomId+"\" style=\"width: 10px; min-width:"+this.frameMinWidth+"; display: block; overflow: hidden; height:"+this.initialHeight+"px; border: none;\" scrolling=\"no\""+this.defaultHeight+"></if"+"rame>";if(this.appendTo===false){document.write(htmlCode);}else{var tmp=document.createElement('div');tmp.innerHTML=htmlCode;var a=this.appendTo;document.getElementById(a).appendChild(tmp.firstChild);}
this.frame=document.getElementById(this.iframeDomId);if(tmp_is_ie===true){try{var iframe=this.frame;var doc=iframe.contentDocument?iframe.contentDocument:(iframe.contentWindow.document||iframe.document);doc.open();doc.write("");}
catch(err){this.frame.src="javascript:void((function(){document.open();document.domain=\'"+this.getBaseDomain()+"\';document.close();})())";}}
this.addEvent(this.frame,'load',this.bindMethod(this.setTimer,this));var self=this;if(window.chrome!==undefined){this.frame.onload=function(){try{var doc=this.contentWindow.document;var _jotform=this.contentWindow.JotForm;if(doc!==undefined){var form=doc.getElementById(""+self.iframeDomId);self.addEvent(form,"submit",function(){if(_jotform.validateAll()){self.formSubmitted=1;}});}}catch(e){}}}};this.addEvent=function(obj,type,fn){if(obj.attachEvent){obj["e"+type+fn]=fn;obj[type+fn]=function(){obj["e"+type+fn](window.event);};obj.attachEvent("on"+type,obj[type+fn]);}
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string=string.replace(new RegExp('src\\=\\"[^"]*captcha.php\"><\/scr'+'ipt>','gim'),'src="http://api.recaptcha.net/js/recaptcha_ajax.js"></scr'+'ipt><'+'div id="recaptcha_div"><'+'/div>'+'<'+'style>#recaptcha_logo{ display:none;} #recaptcha_tagline{display:none;} #recaptcha_table{border:none !important;} .recaptchatable .recaptcha_image_cell, #recaptcha_table{ background-color:transparent !important; } <'+'/style>'+'<'+'script defer="defer"> window.onload = function(){ Recaptcha.create("6Ld9UAgAAAAAAMon8zjt30tEZiGQZ4IIuWXLt1ky", "recaptcha_div", {theme: "clean",tabindex: 0,callback: function (){'+'if (document.getElementById("uword")) { document.getElementById("uword").parentNode.removeChild(document.getElementById("uword")); } if (window["validate"] !== undefined) { if (document.getElementById("recaptcha_response_field")){ document.getElementById("recaptcha_response_field").onblur = function(){ validate(document.getElementById("recaptcha_response_field"), "Required"); } } } if (document.getElementById("recaptcha_response_field")){ document.getElementsByName("recaptcha_challenge_field")[0].setAttribute("name", "anum"); } if (document.getElementById("recaptcha_response_field")){ document.getElementsByName("recaptcha_response_field")[0].setAttribute("name", "qCap"); }}})'+' }<'+'/script>');string=string.replace(/(type="text\/javascript">)\s+(validate\(\"[^"]*"\);)/,'$1 jTime = setInterval(function(){if("validate" in window){$2clearTimeout(jTime);}}, 1000);');if(string.match('#sublabel_litemode')){string=string.replace('class="form-all"','class="form-all" style="margin-top:0;"');}
var iframe=this.frame;var doc=iframe.contentDocument?iframe.contentDocument:(iframe.contentWindow.document||iframe.document);doc.open();doc.write(string);setTimeout(function(){doc.close();try{if('JotFormFrameLoaded'in window){JotFormFrameLoaded();}}catch(e){}},200);};this.setTimer=function(){var self=this;this.interval=setTimeout(this.changeHeight.bind(this),this.timeInterval);};this.getBaseDomain=function(){var thn=window.location.hostname;var cc=0;var buff="";for(var i=0;i<thn.length;i++){var chr=thn.charAt(i);if(chr=="."){cc++;}
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if(cc==2){thn=thn.replace(buff+".","");}
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this.setTimer();};this.bindMethod=function(method,scope){return function(){method.apply(scope,arguments);};};this.frameHeight=0;this.getBodyHeight=function(){if(this.formSubmitted===1){return;}
var height;var scrollHeight;var offsetHeight;try{if(this.frame.contentWindow.document.height){height=this.frame.contentWindow.document.height;if(this.frame.contentWindow.document.body.scrollHeight){height=scrollHeight=this.frame.contentWindow.document.body.scrollHeight;}
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if(isChrome){height=scrollHeight=this.frame.contentWindow.document.height;}
if(this.frame.contentWindow.document.body.offsetHeight){height=offsetHeight=this.frame.contentWindow.document.body.offsetHeight;}
if(scrollHeight&&offsetHeight){height=Math.max(scrollHeight,offsetHeight);}
var formWrapper=this.frame.contentWindow.document.querySelector('.form-all');var margin=parseInt(getComputedStyle(formWrapper).marginTop,10);if(!isNaN(margin)){height+=margin;}}}catch(e){}
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var height=0;try{if(this.frame.contentWindow.window.innerHeight){height=this.frame.contentWindow.window.innerHeight-18;}else if((this.frame.contentWindow.document.documentElement)&&(this.frame.contentWindow.document.documentElement.clientHeight)){height=this.frame.contentWindow.document.documentElement.clientHeight;}else if((this.frame.contentWindow.document.body)&&(this.frame.contentWindow.document.body.clientHeight)){height=this.frame.contentWindow.document.body.clientHeight;}}catch(e){}
return height;};this.getMD5=function(s){function L(k,d){return(k<<d)|(k>>>(32-d))}function K(G,k){var I,d,F,H,x;F=(G&2147483648);H=(k&2147483648);I=(G&1073741824);d=(k&1073741824);x=(G&1073741823)+(k&1073741823);if(I&d){return(x^2147483648^F^H)}if(I|d){if(x&1073741824){return(x^3221225472^F^H)}else{return(x^1073741824^F^H)}}else{return(x^F^H)}}function r(d,F,k){return(d&F)|((~d)&k)}function q(d,F,k){return(d&k)|(F&(~k))}function p(d,F,k){return(d^F^k)}function n(d,F,k){return(F^(d|(~k)))}function u(G,F,aa,Z,k,H,I){G=K(G,K(K(r(F,aa,Z),k),I));return K(L(G,H),F)}function f(G,F,aa,Z,k,H,I){G=K(G,K(K(q(F,aa,Z),k),I));return K(L(G,H),F)}function D(G,F,aa,Z,k,H,I){G=K(G,K(K(p(F,aa,Z),k),I));return K(L(G,H),F)}function t(G,F,aa,Z,k,H,I){G=K(G,K(K(n(F,aa,Z),k),I));return K(L(G,H),F)}function e(G){var Z;var F=G.length;var x=F+8;var k=(x-(x%64))/64;var I=(k+1)*16;var aa=Array(I-1);var d=0;var H=0;while(H<F){Z=(H-(H%4))/4;d=(H%4)*8;aa[Z]=(aa[Z]|(G.charCodeAt(H)<<d));H++}Z=(H-(H%4))/4;d=(H%4)*8;aa[Z]=aa[Z]|(128<<d);aa[I-2]=F<<3;aa[I-1]=F>>>29;return aa}function B(x){var k="",F="",G,d;for(d=0;d<=3;d++){G=(x>>>(d*8))&255;F="0"+G.toString(16);k=k+F.substr(F.length-2,2)}return k}function J(k){k=k.replace(/rn/g,"n");var d="";for(var F=0;F<k.length;F++){var x=k.charCodeAt(F);if(x<128){d+=String.fromCharCode(x)}else{if((x>127)&&(x<2048)){d+=String.fromCharCode((x>>6)|192);d+=String.fromCharCode((x&63)|128)}else{d+=String.fromCharCode((x>>12)|224);d+=String.fromCharCode(((x>>6)&63)|128);d+=String.fromCharCode((x&63)|128)}}}return d}var C=Array();var P,h,E,v,g,Y,X,W,V;var S=7,Q=12,N=17,M=22;var A=5,z=9,y=14,w=20;var o=4,m=11,l=16,j=23;var U=6,T=10,R=15,O=21;s=J(s);C=e(s);Y=1732584193;X=4023233417;W=2562383102;V=271733878;for(P=0;P<C.length;P+=16){h=Y;E=X;v=W;g=V;Y=u(Y,X,W,V,C[P+0],S,3614090360);V=u(V,Y,X,W,C[P+1],Q,3905402710);W=u(W,V,Y,X,C[P+2],N,606105819);X=u(X,W,V,Y,C[P+3],M,3250441966);Y=u(Y,X,W,V,C[P+4],S,4118548399);V=u(V,Y,X,W,C[P+5],Q,1200080426);W=u(W,V,Y,X,C[P+6],N,2821735955);X=u(X,W,V,Y,C[P+7],M,4249261313);Y=u(Y,X,W,V,C[P+8],S,1770035416);V=u(V,Y,X,W,C[P+9],Q,2336552879);W=u(W,V,Y,X,C[P+10],N,4294925233);X=u(X,W,V,Y,C[P+11],M,2304563134);Y=u(Y,X,W,V,C[P+12],S,1804603682);V=u(V,Y,X,W,C[P+13],Q,4254626195);W=u(W,V,Y,X,C[P+14],N,2792965006);X=u(X,W,V,Y,C[P+15],M,1236535329);Y=f(Y,X,W,V,C[P+1],A,4129170786);V=f(V,Y,X,W,C[P+6],z,3225465664);W=f(W,V,Y,X,C[P+11],y,643717713);X=f(X,W,V,Y,C[P+0],w,3921069994);Y=f(Y,X,W,V,C[P+5],A,3593408605);V=f(V,Y,X,W,C[P+10],z,38016083);W=f(W,V,Y,X,C[P+15],y,3634488961);X=f(X,W,V,Y,C[P+4],w,3889429448);Y=f(Y,X,W,V,C[P+9],A,568446438);V=f(V,Y,X,W,C[P+14],z,3275163606);W=f(W,V,Y,X,C[P+3],y,4107603335);X=f(X,W,V,Y,C[P+8],w,1163531501);Y=f(Y,X,W,V,C[P+13],A,2850285829);V=f(V,Y,X,W,C[P+2],z,4243563512);W=f(W,V,Y,X,C[P+7],y,1735328473);X=f(X,W,V,Y,C[P+12],w,2368359562);Y=D(Y,X,W,V,C[P+5],o,4294588738);V=D(V,Y,X,W,C[P+8],m,2272392833);W=D(W,V,Y,X,C[P+11],l,1839030562);X=D(X,W,V,Y,C[P+14],j,4259657740);Y=D(Y,X,W,V,C[P+1],o,2763975236);V=D(V,Y,X,W,C[P+4],m,1272893353);W=D(W,V,Y,X,C[P+7],l,4139469664);X=D(X,W,V,Y,C[P+10],j,3200236656);Y=D(Y,X,W,V,C[P+13],o,681279174);V=D(V,Y,X,W,C[P+0],m,3936430074);W=D(W,V,Y,X,C[P+3],l,3572445317);X=D(X,W,V,Y,C[P+6],j,76029189);Y=D(Y,X,W,V,C[P+9],o,3654602809);V=D(V,Y,X,W,C[P+12],m,3873151461);W=D(W,V,Y,X,C[P+15],l,530742520);X=D(X,W,V,Y,C[P+2],j,3299628645);Y=t(Y,X,W,V,C[P+0],U,4096336452);V=t(V,Y,X,W,C[P+7],T,1126891415);W=t(W,V,Y,X,C[P+14],R,2878612391);X=t(X,W,V,Y,C[P+5],O,4237533241);Y=t(Y,X,W,V,C[P+12],U,1700485571);V=t(V,Y,X,W,C[P+3],T,2399980690);W=t(W,V,Y,X,C[P+10],R,4293915773);X=t(X,W,V,Y,C[P+1],O,2240044497);Y=t(Y,X,W,V,C[P+8],U,1873313359);V=t(V,Y,X,W,C[P+15],T,4264355552);W=t(W,V,Y,X,C[P+6],R,2734768916);X=t(X,W,V,Y,C[P+13],O,1309151649);Y=t(Y,X,W,V,C[P+4],U,4149444226);V=t(V,Y,X,W,C[P+11],T,3174756917);W=t(W,V,Y,X,C[P+2],R,718787259);X=t(X,W,V,Y,C[P+9],O,3951481745);Y=K(Y,h);X=K(X,E);W=K(W,v);V=K(V,g)}var i=B(Y)+B(X)+B(W)+B(V);return i.toLowerCase()};this.init();}
FrameBuilder.get=qsProxy||[];var i53489089313868=new FrameBuilder("53489089313868",false,"","<!DOCTYPE HTML PUBLIC \"-\/\/W3C\/\/DTD HTML 4.01\/\/EN\" \"http:\/\/www.w3.org\/TR\/html4\/strict.dtd\">\n<html class=\"supernova\"><head>\n<meta http-equiv=\"Content-Type\" content=\"text\/html; charset=utf-8\" \/>\n<link rel=\"alternate\" type=\"application\/json+oembed\" href=\"https:\/\/www.jotform.com\/oembed\/?format=json&amp;url=http%3A%2F%2Fwww.jotform.com%2Fform%2F53489089313868\" title=\"oEmbed Form\"><link rel=\"alternate\" type=\"text\/xml+oembed\" href=\"https:\/\/www.jotform.com\/oembed\/?format=xml&amp;url=http%3A%2F%2Fwww.jotform.com%2Fform%2F53489089313868\" title=\"oEmbed Form\">\n<meta property=\"og:title\" content=\"Sign up V4\" >\n<meta property=\"og:url\" content=\"http:\/\/www.jotform.co\/form\/53489089313868\" >\n<meta property=\"og:description\" content=\"Please click the link to complete this form.\">\n<link rel=\"shortcut icon\" href=\"https:\/\/cdn.jotfor.ms\/favicon.ico\">\n<meta name=\"viewport\" content=\"width=device-width, initial-scale=1.0, maximum-scale=1.0, user-scalable=0\" \/>\n<meta name=\"HandheldFriendly\" content=\"true\" \/>\n<title>Sign up V4<\/title>\n<link href=\"https:\/\/cdn.jotfor.ms\/static\/formCss.css?3.3.4791\" rel=\"stylesheet\" type=\"text\/css\" \/>\n<link type=\"text\/css\" media=\"print\" rel=\"stylesheet\" href=\"https:\/\/cdn.jotfor.ms\/css\/printForm.css?3.3.4791\" \/>\n<style type=\"text\/css\">\n    .form-label-left{\n        width:165px;\n    }\n    .form-line{\n        padding-top:12px;\n        padding-bottom:12px;\n    }\n    .form-label-right{\n        width:165px;\n    }\n    body, html{\n        margin:0;\n        padding:0;\n        background:#FFFFFF;\n    }\n\n    .form-all{\n        margin:0px auto;\n        padding-top:20px;\n        width:750px;\n        color:#555555 !important;\n        font-family:'Helvetica';\n        font-size:12px;\n    }\n    .form-radio-item label, .form-checkbox-item label, .form-grading-label, .form-header{\n        color: #555555;\n    }\n\n<\/style>\n\n<style type=\"text\/css\" id=\"form-designer-style\">\n    \/* Injected CSS Code *\/\n.form-all {\n  font-family: \"Helvetica\", sans-serif;\n}\n.form-all {\n  width: 750px;\n}\n.form-label-left,\n.form-label-right {\n  width: 165px;\n}\n.form-label {\n  white-space: normal;\n}\n.form-label.form-label-auto {\n  display: inline-block;\n  float: left;\n  text-align: left;\n  width: 165px;\n}\n.form-label-left {\n  display: inline-block;\n  white-space: normal;\n  float: left;\n  text-align: left;\n}\n.form-label-right {\n  display: inline-block;\n  white-space: normal;\n  float: left;\n  text-align: right;\n}\n.form-label-top {\n  white-space: normal;\n  display: block;\n  float: none;\n  text-align: left;\n}\n.form-all {\n  font-size: 12px;\n}\n.form-label {\n  font-weight: bold;\n}\n.form-checkbox-item label,\n.form-radio-item label {\n  font-weight: normal;\n}\n.supernova {\n  background-color: #ffffff;\n}\n.supernova body {\n  background-color: transparent;\n}\n\/*\n@width30: (unit(@formWidth, px) + 60px);\n@width60: (unit(@formWidth, px)+ 120px);\n@width90: (unit(@formWidth, px)+ 180px);\n*\/\n\/* | *\/\n@media screen and (min-width: 480px) {\n  .supernova .form-all {\n    border: 1px solid #e6e6e6;\n    -webkit-box-shadow: 0 3px 9px rgba(0, 0, 0, 0.1);\n    -moz-box-shadow: 0 3px 9px rgba(0, 0, 0, 0.1);\n    box-shadow: 0 3px 9px rgba(0, 0, 0, 0.1);\n  }\n}\n\/* | *\/\n\/* | *\/\n@media screen and (max-width: 480px) {\n  .jotform-form {\n    padding: 10px 0;\n  }\n}\n\/* | *\/\n\/* | *\/\n@media screen and (min-width: 480px) and (max-width: 768px) {\n  .jotform-form {\n    padding: 30px 0;\n  }\n}\n\/* | *\/\n\/* | *\/\n@media screen and (min-width: 480px) and (max-width: 749px) {\n  .jotform-form {\n    padding: 30px 0;\n  }\n}\n\/* | *\/\n\/* | *\/\n@media screen and (min-width: 768px) {\n  .jotform-form {\n    padding: 60px 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{\"days\":{\"monday\":true,\"tuesday\":true,\"wednesday\":true,\"thursday\":true,\"friday\":true,\"saturday\":false,\"sunday\":false},\"future\":true,\"past\":false,\"custom\":[\"25\/03\/2016\",\"28\/03\/2016\",\"25\/04\/2016\"],\"ranges\":false,\"start\":\"\",\"end\":\"\"});\n      JotForm.description('input_75', 'If you are moving in or require electricity to be turned on within THREE (3) business days PLEASE CALL 1300 838 009 ASAP (during business hours) Additional Fees may apply.');\n      JotForm.description('input_30', 'please select your customer type Home or<br \/>Business');\n      setTimeout(function() {\n          $('input_64').hint('eg: locked gate which will be left unlocked');\n       }, 20);\n      JotForm.description('input_64', 'access to your meter may be required for meter reading or power turn on purposes - please describe the meter access issue (ie: due to locked gate, dog, other)');\n      JotForm.description('input_52', '10 or 11 digits');\n      setTimeout(function() {\n          $('input_162').hint('eg: 2.5');\n       }, 20);\n\n JotForm.calendarMonths = [\"January\",\"February\",\"March\",\"April\",\"May\",\"June\",\"July\",\"August\",\"September\",\"October\",\"November\",\"December\"];\n JotForm.calendarDays = [\"Sunday\",\"Monday\",\"Tuesday\",\"Wednesday\",\"Thursday\",\"Friday\",\"Saturday\",\"Sunday\"];\n JotForm.calendarOther = {\"today\":\"Today\"};\n var languageOptions = document.querySelectorAll('#langList li'); \n for(var langIndex = 0; langIndex < languageOptions.length; langIndex++) { \n   languageOptions[langIndex].on('click', function(e) { setTimeout(function(){ JotForm.setCalendar(\"163\", false, {\"days\":{\"monday\":true,\"tuesday\":true,\"wednesday\":true,\"thursday\":true,\"friday\":true,\"saturday\":true,\"sunday\":true},\"future\":true,\"past\":true,\"custom\":false,\"ranges\":false,\"start\":\"\",\"end\":\"\"}); }, 0); });\n } \n JotForm.setCalendar(\"163\", false, 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Sorry, we don\\'t accept Amex. 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A&nbsp;surcharge may apply for Credit Card payments.\",\"type\":\"control_text\"},{\"name\":\"nameOn\",\"qid\":\"113\",\"text\":\"Name on card\",\"type\":\"control_textbox\"},{\"description\":\"Please note we accept Visa and Mastercard. 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If you are unsure you can count your solar panels, usually there are 4 solar panels to 1 kW.\u00a0\",\"type\":\"control_text\"},{\"name\":\"solarSystem162\",\"qid\":\"162\",\"subLabel\":\"Please enter capacity in kiloWatts (kW) (1kW = 1000 Watts)\",\"text\":\"Solar system capacity kW\",\"type\":\"control_number\"},{\"name\":\"solarInstallation\",\"qid\":\"163\",\"text\":\"Solar installation date\",\"type\":\"control_datetime\"},{\"name\":\"doYou164\",\"qid\":\"164\",\"text\":\"Do you receive a govt regulated feed-in tariff (existing solar only)?\",\"type\":\"control_dropdown\"},{\"name\":\"doubleclickTo165\",\"qid\":\"165\",\"text\":\"You have requested a power turn on for tomorrow, please call us on 1300 838 009&nbsp;ASAP after you have completed your sign up.&nbsp;\",\"type\":\"control_text\"},{\"name\":\"clickTo166\",\"qid\":\"166\",\"text\":\"Step 3: Other Details\",\"type\":\"control_head\"},null,null,{\"name\":\"streetName169\",\"qid\":\"169\",\"text\":\"Street name and type\",\"type\":\"control_textbox\"},{\"name\":\"suburb170\",\"qid\":\"170\",\"text\":\"Suburb\",\"type\":\"control_textbox\"},{\"name\":\"state171\",\"qid\":\"171\",\"text\":\"State\",\"type\":\"control_dropdown\"},{\"name\":\"postcode172\",\"qid\":\"172\",\"text\":\"Postcode\",\"type\":\"control_textbox\"},{\"name\":\"doubleclickTo173\",\"qid\":\"173\",\"text\":\"Postal address\",\"type\":\"control_text\"},{\"name\":\"doubleclickTo174\",\"qid\":\"174\",\"text\":\"By clicking Sign Up below, I understand that:\\n1. Diamond Energy will review the information I have provided in this online application which forms my Retail Supply Agreement, my tariff and metering details and advise me of any changes in the relevant Charges as appropriate or contact me if further information is required;\\n2. Charges (including the amount and structure of any Charge), discounts, Feed-in Rates and Terms and Conditions may be varied from time to time and I will be notified in accordance with the Terms and Conditions;\u00a0\\n3. I am entering into an Agreement with Diamond Energy which includes the relevant Terms and Important Information in relation to the Supply Address, which will be emailed to me in a Welcome Pack shortly; and\\n4. Any right to a cooling off period will be included in my Welcome Pack.\\nI confirm that I am authorised to enter into this Agreement and I have read, understand and accept the terms of the Agreement and give my explicit informed consent.\\nIf I have included my direct debit details:\\n1. I understand that Diamond Energy cannot make credit payments into a nominated credit card account. I also understand that if I am nominating a joint account for direct debit payments, authorisation and proof of authority may be required from each joint account holder;\\n2. I authorise Diamond Energy to verify the details of my account with my Financial Institution and I authorize my nominated Financial Institution to release information to Diamond Energy to verify the account details; and\\n3. I consent Diamond Energy Retail Pty Ltd (User Identification number 419899) to direct debit my nominated account through the Bulk Electronic Clearing System, in accordance with Direct Debit Terms &amp; Conditions until further notice.\",\"type\":\"control_text\"},{\"name\":\"flat175\",\"qid\":\"175\",\"text\":\"Flat \/ Unit number\",\"type\":\"control_textbox\"},{\"name\":\"streetNumber176\",\"qid\":\"176\",\"text\":\"Street number\",\"type\":\"control_textbox\"},{\"name\":\"poBox\",\"qid\":\"177\",\"text\":\"PO Box \/ Flat \/ Unit number\",\"type\":\"control_textbox\"},null,{\"name\":\"streetNumber\",\"qid\":\"179\",\"text\":\"Street number\",\"type\":\"control_textbox\"},{\"description\":\"Diamond Pure Plus 100%; 5.50c\/kWh\\nDiamond Pure Plus 50%; 2.75c\/kWh\\nDiamond Pure Plus 20%; 1.10c\/kWh\",\"name\":\"interestedIn\",\"qid\":\"180\",\"text\":\"Interested in GreenPower?\",\"type\":\"control_dropdown\"}]);\n   setTimeout(function() {\nJotForm.paymentExtrasOnTheFly([null,null,null,null,null,null,null,null,null,null,{\"description\":\"\",\"name\":\"acctrep-yourName\",\"qid\":\"10\",\"text\":\"Your name\",\"type\":\"control_fullname\"},null,{\"description\":\"\",\"name\":\"acctrep-dateofbirth\",\"qid\":\"12\",\"text\":\"Date of birth\",\"type\":\"control_birthdate\"},null,{\"name\":\"primaryContact14\",\"qid\":\"14\",\"subLabel\":\"Please refrain from using hyphens or spaces\",\"text\":\"Primary contact number         (incl. area code)\",\"type\":\"control_number\"},{\"name\":\"input15\",\"qid\":\"15\",\"text\":\"\",\"type\":\"control_checkbox\"},null,{\"name\":\"clickTo17\",\"qid\":\"17\",\"text\":\"Step 1: Account Holder\",\"type\":\"control_head\"},{\"name\":\"clickTo\",\"qid\":\"18\",\"text\":\"Step 2: Supply Address Details\",\"type\":\"control_head\"},null,{\"description\":\"we prefer email for all notices and invoices - please ensure our emails to you are not blocked or directed to spam folders\",\"name\":\"acctrep-yourEmail\",\"qid\":\"20\",\"text\":\"Your email address\",\"type\":\"control_email\"},null,{\"name\":\"secondaryContact22\",\"qid\":\"22\",\"text\":\"Secondary contact name\",\"type\":\"control_fullname\"},{\"name\":\"secondaryContact23\",\"qid\":\"23\",\"text\":\"Secondary contact email address\",\"type\":\"control_email\"},null,{\"description\":\"\",\"name\":\"secondaryContact25\",\"qid\":\"25\",\"text\":\"Secondary contact date of birth\",\"type\":\"control_birthdate\"},{\"name\":\"input26\",\"qid\":\"26\",\"text\":\"\",\"type\":\"control_checkbox\"},null,null,null,{\"description\":\"please select your customer type Home or\\nBusiness\",\"name\":\"customerType30\",\"qid\":\"30\",\"text\":\"Customer type\",\"type\":\"control_dropdown\"},null,{\"name\":\"anyOther\",\"qid\":\"32\",\"text\":\"Any other comments?\",\"type\":\"control_textarea\"},null,{\"description\":\"if selected we will contact you to confirm your concession details\",\"name\":\"areYou34\",\"qid\":\"34\",\"text\":\"Are you a concession card holder?\",\"type\":\"control_checkbox\"},{\"description\":\"if selected we will contact you to confirm your life support details\",\"name\":\"lifeSupport35\",\"qid\":\"35\",\"text\":\"Do you have powered life support equipment?\",\"type\":\"control_checkbox\"},null,null,null,null,null,null,null,null,null,{\"name\":\"submit\",\"qid\":\"45\",\"text\":\"Sign up\",\"type\":\"control_button\"},null,null,null,{\"name\":\"clickTo49\",\"qid\":\"49\",\"text\":\"Step 4: Confirmation\",\"type\":\"control_head\"},null,{\"name\":\"pleaseEnter\",\"qid\":\"51\",\"text\":\"Please enter the text as shown in the box\",\"type\":\"control_captcha\"},{\"description\":\"10 or 11 digits\",\"name\":\"nmiNumber52\",\"qid\":\"52\",\"subLabel\":\"This is your National Meter Identifier number found on your electricity bills. 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You will receive your bill and 14 days later we\u00a0will process your invoice total via your nominated bank account or credit card - it's effortless!\",\"type\":\"control_text\"},null,{\"name\":\"toProceed\",\"qid\":\"105\",\"text\":\"To proceed with Direct Debit payment method choose one of the following:\",\"type\":\"control_checkbox\"},{\"name\":\"doubleclickTo106\",\"qid\":\"106\",\"text\":\"Bank Account Details\\nIf you would like us to debit your invoice total from your bank account, please enter your bank account details below.&nbsp;\",\"type\":\"control_text\"},{\"name\":\"financialInstitution\",\"qid\":\"107\",\"text\":\"Financial Institution\",\"type\":\"control_textbox\"},{\"name\":\"accountHolder\",\"qid\":\"108\",\"text\":\"Account Holder\",\"type\":\"control_textbox\"},{\"name\":\"branchAddress\",\"qid\":\"109\",\"text\":\"Branch Address\",\"type\":\"control_textbox\"},{\"name\":\"bsb\",\"qid\":\"110\",\"text\":\"BSB\",\"type\":\"control_textbox\"},{\"name\":\"accountNumber\",\"qid\":\"111\",\"text\":\"Account Number\",\"type\":\"control_textbox\"},{\"name\":\"doubleclickTo112\",\"qid\":\"112\",\"text\":\"Credit Card Details\\nIf you would like us to debit your invoice total from your credit card, please enter one below.We accept Mastercard or Visa, but not AMEX. A&nbsp;surcharge may apply for Credit Card payments.\",\"type\":\"control_text\"},{\"name\":\"nameOn\",\"qid\":\"113\",\"text\":\"Name on card\",\"type\":\"control_textbox\"},{\"description\":\"Please note we accept Visa and Mastercard. Sorry, we don't accept Amex. \",\"name\":\"creditCard114\",\"qid\":\"114\",\"subLabel\":\"Typically a 16 digit number on your credit card, no space or hyphens please\",\"text\":\"Credit Card number\",\"type\":\"control_textbox\"},null,null,{\"name\":\"ccvNumber\",\"qid\":\"117\",\"subLabel\":\"3 digit number on back of card\",\"text\":\"CCV number\",\"type\":\"control_textbox\"},null,null,null,null,{\"name\":\"cardExpiry122\",\"qid\":\"122\",\"text\":\"Card expiry month\",\"type\":\"control_dropdown\"},null,{\"name\":\"cardExpiry\",\"qid\":\"124\",\"text\":\"Card expiry year\",\"type\":\"control_dropdown\"},{\"name\":\"wouldYou\",\"qid\":\"125\",\"text\":\"Would you like to receive updates on our promotions?\",\"type\":\"control_checkbox\"},null,null,null,null,null,null,null,null,null,null,null,{\"name\":\"alternateContact\",\"qid\":\"137\",\"text\":\"Alternate contact number\",\"type\":\"control_number\"},{\"name\":\"state\",\"qid\":\"138\",\"text\":\"State\",\"type\":\"control_dropdown\"},null,{\"name\":\"doubleclickTo140\",\"qid\":\"140\",\"text\":\"You have requested a same day power turn on, please call us on 1300 838 009 ASAP after you have completed your sign up. Please note, same day power turn on requests can incur additional charges. \",\"type\":\"control_text\"},{\"name\":\"isYour141\",\"qid\":\"141\",\"text\":\"Is your electricity meter accessible?\",\"type\":\"control_checkbox\"},null,null,{\"name\":\"promotionalCode\",\"qid\":\"144\",\"text\":\"Promotional code\",\"type\":\"control_textbox\"},null,null,null,null,null,null,{\"name\":\"streetName151\",\"qid\":\"151\",\"text\":\"Street name and type\",\"type\":\"control_textbox\"},{\"name\":\"suburb\",\"qid\":\"152\",\"text\":\"Suburb\",\"type\":\"control_textbox\"},{\"name\":\"postcode\",\"qid\":\"153\",\"text\":\"Postcode\",\"type\":\"control_textbox\"},null,null,{\"name\":\"doYou\",\"qid\":\"156\",\"text\":\"Do you have a solar system?\",\"type\":\"control_checkbox\"},{\"name\":\"solarSystem\",\"qid\":\"157\",\"text\":\"Solar system installer \",\"type\":\"control_textbox\"},{\"name\":\"solarPanel\",\"qid\":\"158\",\"subLabel\":\"(If known)\",\"text\":\"Solar panel manufacturer\",\"type\":\"control_dropdown\"},{\"name\":\"other\",\"qid\":\"159\",\"subLabel\":\"If your solar panel manufacturer is not in the above list please enter here\",\"text\":\"Other\",\"type\":\"control_textbox\"},null,{\"name\":\"doubleclickTo\",\"qid\":\"161\",\"text\":\"You have selected a fairly large solar system size (greater than 50 kW), please check the size you have entered is correct. If you are unsure you can count your solar panels, usually there are 4 solar panels to 1 kW.\u00a0\",\"type\":\"control_text\"},{\"name\":\"solarSystem162\",\"qid\":\"162\",\"subLabel\":\"Please enter capacity in kiloWatts (kW) (1kW = 1000 Watts)\",\"text\":\"Solar system capacity kW\",\"type\":\"control_number\"},{\"name\":\"solarInstallation\",\"qid\":\"163\",\"text\":\"Solar installation date\",\"type\":\"control_datetime\"},{\"name\":\"doYou164\",\"qid\":\"164\",\"text\":\"Do you receive a govt regulated feed-in tariff (existing solar only)?\",\"type\":\"control_dropdown\"},{\"name\":\"doubleclickTo165\",\"qid\":\"165\",\"text\":\"You have requested a power turn on for tomorrow, please call us on 1300 838 009&nbsp;ASAP after you have completed your sign up.&nbsp;\",\"type\":\"control_text\"},{\"name\":\"clickTo166\",\"qid\":\"166\",\"text\":\"Step 3: Other Details\",\"type\":\"control_head\"},null,null,{\"name\":\"streetName169\",\"qid\":\"169\",\"text\":\"Street name and type\",\"type\":\"control_textbox\"},{\"name\":\"suburb170\",\"qid\":\"170\",\"text\":\"Suburb\",\"type\":\"control_textbox\"},{\"name\":\"state171\",\"qid\":\"171\",\"text\":\"State\",\"type\":\"control_dropdown\"},{\"name\":\"postcode172\",\"qid\":\"172\",\"text\":\"Postcode\",\"type\":\"control_textbox\"},{\"name\":\"doubleclickTo173\",\"qid\":\"173\",\"text\":\"Postal address\",\"type\":\"control_text\"},{\"name\":\"doubleclickTo174\",\"qid\":\"174\",\"text\":\"By clicking Sign Up below, I understand that:\\n1. Diamond Energy will review the information I have provided in this online application which forms my Retail Supply Agreement, my tariff and metering details and advise me of any changes in the relevant Charges as appropriate or contact me if further information is required;\\n2. Charges (including the amount and structure of any Charge), discounts, Feed-in Rates and Terms and Conditions may be varied from time to time and I will be notified in accordance with the Terms and Conditions;\u00a0\\n3. I am entering into an Agreement with Diamond Energy which includes the relevant Terms and Important Information in relation to the Supply Address, which will be emailed to me in a Welcome Pack shortly; and\\n4. Any right to a cooling off period will be included in my Welcome Pack.\\nI confirm that I am authorised to enter into this Agreement and I have read, understand and accept the terms of the Agreement and give my explicit informed consent.\\nIf I have included my direct debit details:\\n1. I understand that Diamond Energy cannot make credit payments into a nominated credit card account. I also understand that if I am nominating a joint account for direct debit payments, authorisation and proof of authority may be required from each joint account holder;\\n2. I authorise Diamond Energy to verify the details of my account with my Financial Institution and I authorize my nominated Financial Institution to release information to Diamond Energy to verify the account details; and\\n3. I consent Diamond Energy Retail Pty Ltd (User Identification number 419899) to direct debit my nominated account through the Bulk Electronic Clearing System, in accordance with Direct Debit Terms &amp; Conditions until further notice.\",\"type\":\"control_text\"},{\"name\":\"flat175\",\"qid\":\"175\",\"text\":\"Flat \/ Unit number\",\"type\":\"control_textbox\"},{\"name\":\"streetNumber176\",\"qid\":\"176\",\"text\":\"Street number\",\"type\":\"control_textbox\"},{\"name\":\"poBox\",\"qid\":\"177\",\"text\":\"PO Box \/ Flat \/ Unit number\",\"type\":\"control_textbox\"},null,{\"name\":\"streetNumber\",\"qid\":\"179\",\"text\":\"Street number\",\"type\":\"control_textbox\"},{\"description\":\"Diamond Pure Plus 100%; 5.50c\/kWh\\nDiamond Pure Plus 50%; 2.75c\/kWh\\nDiamond Pure Plus 20%; 1.10c\/kWh\",\"name\":\"interestedIn\",\"qid\":\"180\",\"text\":\"Interested in GreenPower?\",\"type\":\"control_dropdown\"}]);}, 20); \n<\/script>\n<\/head>\n<body>\n<form class=\"jotform-form\" action=\"https:\/\/submit.jotform.co\/submit\/53489089313868\/\" method=\"post\" name=\"form_53489089313868\" id=\"53489089313868\" accept-charset=\"utf-8\">\n  <input type=\"hidden\" name=\"formID\" value=\"53489089313868\" \/>\n  <div class=\"form-all\">\n    <ul class=\"form-section page-section\">\n      <li class=\"form-line\" data-type=\"control_widget\" id=\"id_79\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_79\" for=\"input_79\"> loading... <\/label>\n        <div id=\"cid_79\" class=\"\">\n          <div style=\"width:100%;text-align:Left;\" data-component=\"widget-directEmbed\">\n            <div class=\"direct-embed-widgets \" data-type=\"direct-embed\" style=\"width:50px;height:50px;\">\n              <input type=\"hidden\" id=\"input_79\" name=\"q79_loading\" class=\"form-hidden getRef\">\n              <script type=\"text\/javascript\" src=\"https:\/\/widgets.jotform.io\/getReferrer\/main.js\"><\/script>\n            <\/div>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_widget\" id=\"id_59\">\n        <div id=\"cid_59\" class=\"\">\n          <div style=\"width:100%;text-align:Left;\" data-component=\"widget-directEmbed\">\n            <div class=\"direct-embed-widgets widget-static\" data-type=\"direct-embed\" style=\"width:50px;height:40px;\">\n              <div class=\"form_tabs_widget\">\n                <script type=\"text\/javascript\">\n                  var formTitleShow = 'No'\n  var tabTitles = 'Account Holder,Supply Address Details, Other Details,Confirmation'.split(',');\n  var tabsCustomCss = '';\n  var navigateWithoutValidation = 'No';\n  var formTabsTheme = 'default';\n                <\/script>\n                <script src=\"\/\/widgets.jotform.io\/formTabs\/scripts.min.js\" type=\"text\/javascript\"><\/script>\n              <\/div>\n            <\/div>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li id=\"cid_17\" class=\"form-input-wide\" data-type=\"control_head\">\n        <div class=\"form-header-group \">\n          <div class=\"header-text httal htvam\">\n            <h3 id=\"header_17\" class=\"form-header\" data-component=\"header\">\n              Step 1: Account Holder\n            <\/h3>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_dropdown\" id=\"id_80\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_80\" for=\"input_80\"> Preferred title <\/label>\n        <div id=\"cid_80\" class=\"form-input\">\n          <select class=\"form-dropdown\" id=\"input_80\" name=\"q80_acctrep-preferredTitle\" style=\"width:150px;\" data-component=\"dropdown\">\n            <option value=\"\"> please select <\/option>\n            <option value=\"Mr\"> Mr <\/option>\n            <option value=\"Miss\"> Miss <\/option>\n            <option value=\"Mrs\"> Mrs <\/option>\n            <option value=\"Ms\"> Ms <\/option>\n            <option value=\"Dr\"> Dr <\/option>\n            <option value=\"Prof\"> Prof <\/option>\n            <option value=\"Mx\"> Mx <\/option>\n          <\/select>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_fullname\" id=\"id_10\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_10\" for=\"first_10\">\n          Your name\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_10\" 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_10\" name=\"q10_acctrep-yourName[first]\" class=\"form-textbox validate[required]\" size=\"10\" value=\"\" data-component=\"first\" required=\"\" \/>\n              <label class=\"form-sub-label\" for=\"first_10\" 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_10\" name=\"q10_acctrep-yourName[last]\" class=\"form-textbox validate[required]\" size=\"15\" value=\"\" data-component=\"last\" required=\"\" \/>\n              <label class=\"form-sub-label\" for=\"last_10\" id=\"sublabel_last\" style=\"min-height:13px;\"> Last Name <\/label>\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_email\" id=\"id_20\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_20\" for=\"input_20\"> Your email address <\/label>\n        <div id=\"cid_20\" class=\"form-input\">\n          <div data-wrapper-react=\"true\">\n            <input type=\"email\" id=\"input_20\" name=\"q20_acctrep-yourEmail\" class=\"form-textbox validate[Email]\" size=\"30\" value=\"\" placeholder=\"eg: myname@example.com\" data-component=\"email\" \/>\n            <br\/>\n            <label class=\"form-sub-label\" style=\"display:none;\" for=\"input_20_confirm\"> Confirmation Email <\/label>\n            <input type=\"email\" id=\"input_20_confirm\" name=\"q20_acctrep-yourEmail\" class=\"form-textbox validate[Email, Email_Confirm]\" style=\"margin-top:8px;\" size=\"30\" value=\"\" placeholder=\"please confirm your email address\" data-component=\"emailConfirmation\" \/>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_number\" id=\"id_14\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_14\" for=\"input_14\">\n          Primary contact number (incl. area code)\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_14\" class=\"form-input jf-required\">\n          <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n            <input type=\"number\" id=\"input_14\" name=\"q14_primaryContact14\" data-type=\"input-number\" class=\" form-number-input form-textbox validate[required]\" style=\"width:100px;\" size=\"10\" value=\"\" placeholder=\" \" data-component=\"number\" required=\"\" \/>\n            <label class=\"form-sub-label\" for=\"input_14\" style=\"min-height:13px;\"> Please refrain from using hyphens or spaces <\/label>\n          <\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_number\" id=\"id_137\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_137\" for=\"input_137\"> Alternate contact number <\/label>\n        <div id=\"cid_137\" class=\"form-input\">\n          <input type=\"number\" id=\"input_137\" name=\"q137_alternateContact\" data-type=\"input-number\" class=\" form-number-input form-textbox\" style=\"width:100px;\" size=\"10\" value=\"\" placeholder=\" \" data-component=\"number\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_birthdate\" id=\"id_12\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_12\" for=\"input_12\">\n          Date of birth\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_12\" 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=\"q12_acctrep-dateofbirth[day]\" id=\"input_12_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_12_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=\"q12_acctrep-dateofbirth[month]\" id=\"input_12_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_12_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=\"q12_acctrep-dateofbirth[year]\" id=\"input_12_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_12_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_dropdown\" id=\"id_66\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_66\" for=\"input_66\">\n          Identification type\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_66\" class=\"form-input jf-required\">\n          <select class=\"form-dropdown validate[required]\" id=\"input_66\" name=\"q66_acctrep-idtype\" style=\"width:150px;\" data-component=\"dropdown\" required=\"\">\n            <option value=\"\">  <\/option>\n            <option value=\"Drivers Licence No\"> Drivers Licence No <\/option>\n            <option value=\"Medicare Card No\"> Medicare Card No <\/option>\n            <option value=\"Passport No\"> Passport No <\/option>\n          <\/select>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_textbox\" id=\"id_65\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_65\" for=\"input_65\">\n          Identification no.\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_65\" class=\"form-input jf-required\">\n          <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n            <input type=\"text\" id=\"input_65\" name=\"q65_acctrep-idno\" data-type=\"input-textbox\" class=\"form-textbox validate[required]\" size=\"20\" value=\"\" placeholder=\" \" data-component=\"textbox\" required=\"\" \/>\n            <label class=\"form-sub-label\" for=\"input_65\" style=\"min-height:13px;\"> Please provide the matching identification number <\/label>\n          <\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_checkbox\" id=\"id_15\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_15\" for=\"input_15_0\">  <\/label>\n        <div id=\"cid_15\" 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_15_0\" name=\"q15_input15[]\" value=\"Click here if you would like to add a secondary account representative\" \/>\n              <label id=\"label_input_15_0\" for=\"input_15_0\"> Click here if you would like to add a secondary account representative <\/label>\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line form-field-hidden\" style=\"display:none;\" data-type=\"control_dropdown\" id=\"id_81\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_81\" for=\"input_81\"> Preferred title <\/label>\n        <div id=\"cid_81\" class=\"form-input\">\n          <select class=\"form-dropdown\" id=\"input_81\" name=\"q81_title\" style=\"width:90px;\" data-component=\"dropdown\">\n            <option value=\"\"> please select <\/option>\n            <option value=\"Mr\"> Mr <\/option>\n            <option value=\"Miss\"> Miss <\/option>\n            <option value=\"Mrs\"> Mrs <\/option>\n            <option value=\"Ms\"> Ms <\/option>\n            <option value=\"Dr\"> Dr <\/option>\n            <option value=\"Prof\"> Prof <\/option>\n          <\/select>\n        <\/div>\n      <\/li>\n      <li class=\"form-line form-field-hidden\" style=\"display:none;\" data-type=\"control_fullname\" id=\"id_22\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_22\" for=\"first_22\"> Secondary contact name <\/label>\n        <div id=\"cid_22\" class=\"form-input\">\n          <div data-wrapper-react=\"true\">\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n              <input type=\"text\" id=\"first_22\" name=\"q22_secondaryContact22[first]\" class=\"form-textbox\" size=\"10\" value=\"\" data-component=\"first\" \/>\n              <label class=\"form-sub-label\" for=\"first_22\" 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_22\" name=\"q22_secondaryContact22[last]\" class=\"form-textbox\" size=\"15\" value=\"\" data-component=\"last\" \/>\n              <label class=\"form-sub-label\" for=\"last_22\" id=\"sublabel_last\" style=\"min-height:13px;\"> Last Name <\/label>\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line form-field-hidden\" style=\"display:none;\" data-type=\"control_email\" id=\"id_23\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_23\" for=\"input_23\"> Secondary contact email address <\/label>\n        <div id=\"cid_23\" class=\"form-input\">\n          <div data-wrapper-react=\"true\">\n            <input type=\"email\" id=\"input_23\" name=\"q23_secondaryContact23\" class=\"form-textbox validate[Email]\" size=\"30\" value=\"\" placeholder=\"eg: myname@example.com\" data-component=\"email\" \/>\n            <br\/>\n            <label class=\"form-sub-label\" style=\"display:none;\" for=\"input_23_confirm\"> Confirmation Email <\/label>\n            <input type=\"email\" id=\"input_23_confirm\" name=\"q23_secondaryContact23\" class=\"form-textbox validate[Email, Email_Confirm]\" style=\"margin-top:8px;\" size=\"30\" value=\"\" placeholder=\"please confirm email address\" data-component=\"emailConfirmation\" \/>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line form-field-hidden\" style=\"display:none;\" data-type=\"control_number\" id=\"id_98\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_98\" for=\"input_98\"> Secondary contact preferred contact number (incl. area code) <\/label>\n        <div id=\"cid_98\" class=\"form-input\">\n          <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n            <input type=\"number\" id=\"input_98\" name=\"q98_secondaryContact\" data-type=\"input-number\" class=\" form-number-input form-textbox\" style=\"width:100px;\" size=\"10\" value=\"\" maxlength=\"10\" placeholder=\" \" data-numbermin=\"1\" data-component=\"number\" \/>\n            <label class=\"form-sub-label\" for=\"input_98\" style=\"min-height:13px;\"> Please refrain from using spaces or hyphens <\/label>\n          <\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line form-field-hidden\" style=\"display:none;\" data-type=\"control_birthdate\" id=\"id_25\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_25\" for=\"input_25\"> Secondary contact date of birth <\/label>\n        <div id=\"cid_25\" class=\"form-input\">\n          <div data-wrapper-react=\"true\">\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n              <select name=\"q25_secondaryContact25[day]\" id=\"input_25_day\" class=\"form-dropdown\" 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_25_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=\"q25_secondaryContact25[month]\" id=\"input_25_month\" class=\"form-dropdown\" 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_25_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=\"q25_secondaryContact25[year]\" id=\"input_25_year\" class=\"form-dropdown\" 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_25_year\" id=\"sublabel_year\" style=\"min-height:13px;\"> Year <\/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_18\" class=\"form-input-wide\" data-type=\"control_head\">\n        <div class=\"form-header-group \">\n          <div class=\"header-text httal htvam\">\n            <h3 id=\"header_18\" class=\"form-header\" data-component=\"header\">\n              Step 2: Supply Address Details\n            <\/h3>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_checkbox\" id=\"id_67\">\n        <label class=\"form-label form-label-left\" id=\"label_67\" for=\"input_67_0\"> Are you MOVING IN or do you want the power TURNED ON in your name? <\/label>\n        <div id=\"cid_67\" 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_67_0\" name=\"q67_areYou67[]\" value=\"Yes\" \/>\n              <label id=\"label_input_67_0\" for=\"input_67_0\"> Yes <\/label>\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required form-field-hidden\" style=\"display:none;\" data-type=\"control_datetime\" id=\"id_75\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_75\" for=\"day_75\">\n          Enter the date you would like the power turned on\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_75\" 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, disallowPast, limitDate]\" id=\"day_75\" name=\"q75_enterThe[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_75\" 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, disallowPast, limitDate]\" id=\"month_75\" name=\"q75_enterThe[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_75\" 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, disallowPast, limitDate]\" id=\"year_75\" name=\"q75_enterThe[year]\" type=\"tel\" size=\"4\" data-maxlength=\"4\" value=\"\" required=\"\" \/>\n              <label class=\"form-sub-label\" for=\"year_75\" 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_75_pick\" src=\"https:\/\/cdn.jotfor.ms\/images\/calendar.png\" style=\"vertical-align:middle;\" data-component=\"datetime\" \/>\n              <label class=\"form-sub-label\" for=\"input_75_pick\" style=\"min-height:13px;\">  <\/label>\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line form-field-hidden\" style=\"display:none;\" data-type=\"control_text\" id=\"id_140\">\n        <div id=\"cid_140\" class=\"form-input-wide\">\n          <div id=\"text_140\" class=\"form-html\" data-component=\"text\">\n            <p><span style=\"color:#ff0000;\">You have requested a same day power turn on, <strong><span style=\"text-decoration:underline;\">please call us on 1300 838 009 ASAP<\/span><\/strong> after you have completed your sign up. Please note, same day power turn on requests can incur additional charges. <\/span><\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line form-field-hidden\" style=\"display:none;\" data-type=\"control_text\" id=\"id_165\">\n        <div id=\"cid_165\" class=\"form-input-wide\">\n          <div id=\"text_165\" class=\"form-html\" data-component=\"text\">\n            <p><span style=\"color: #ff0000;\">You have requested a power turn on for tomorrow, <span style=\"text-decoration: underline;\"><strong>please call us on 1300 838 009 ASAP<\/strong><\/span> after you have completed your sign up. <\/span><\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_dropdown\" id=\"id_30\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_30\" for=\"input_30\"> Customer type <\/label>\n        <div id=\"cid_30\" class=\"form-input\">\n          <select class=\"form-dropdown\" id=\"input_30\" name=\"q30_customerType30\" style=\"width:140px;\" data-component=\"dropdown\">\n            <option value=\"\"> please select <\/option>\n            <option selected=\"\" value=\"home\"> home <\/option>\n            <option value=\"business\"> business <\/option>\n          <\/select>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_textbox\" id=\"id_175\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_175\" for=\"input_175\"> Flat \/ Unit number <\/label>\n        <div id=\"cid_175\" class=\"form-input\">\n          <input type=\"text\" id=\"input_175\" name=\"q175_flat175\" data-type=\"input-textbox\" class=\"form-textbox\" size=\"7\" value=\"\" placeholder=\" \" data-component=\"textbox\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_textbox\" id=\"id_176\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_176\" for=\"input_176\">\n          Street number\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_176\" class=\"form-input jf-required\">\n          <input type=\"text\" id=\"input_176\" name=\"q176_streetNumber176\" data-type=\"input-textbox\" class=\"form-textbox validate[required]\" size=\"7\" value=\"\" placeholder=\" \" data-component=\"textbox\" required=\"\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_textbox\" id=\"id_151\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_151\" for=\"input_151\">\n          Street name and type\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_151\" class=\"form-input jf-required\">\n          <input type=\"text\" id=\"input_151\" name=\"q151_streetName151\" data-type=\"input-textbox\" class=\"form-textbox validate[required]\" size=\"20\" value=\"\" placeholder=\" \" data-component=\"textbox\" required=\"\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_textbox\" id=\"id_152\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_152\" for=\"input_152\">\n          Suburb\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_152\" class=\"form-input jf-required\">\n          <input type=\"text\" id=\"input_152\" name=\"q152_suburb\" data-type=\"input-textbox\" class=\"form-textbox validate[required]\" size=\"20\" value=\"\" placeholder=\" \" data-component=\"textbox\" required=\"\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_dropdown\" id=\"id_138\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_138\" for=\"input_138\">\n          State\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_138\" class=\"form-input jf-required\">\n          <select class=\"form-dropdown validate[required]\" id=\"input_138\" name=\"q138_state\" style=\"width:130px;\" data-component=\"dropdown\" required=\"\">\n            <option value=\"\">  <\/option>\n            <option value=\"NSW\"> NSW <\/option>\n            <option value=\"QLD\"> QLD <\/option>\n            <option value=\"SA\"> SA <\/option>\n            <option value=\"VIC\"> VIC <\/option>\n          <\/select>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_textbox\" id=\"id_153\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_153\" for=\"input_153\">\n          Postcode\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_153\" class=\"form-input jf-required\">\n          <input type=\"text\" id=\"input_153\" name=\"q153_postcode\" data-type=\"input-textbox\" class=\"form-textbox validate[required, Numeric]\" size=\"20\" value=\"\" maxlength=\"4\" placeholder=\" \" data-component=\"textbox\" required=\"\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_checkbox\" id=\"id_26\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_26\" for=\"input_26_0\">  <\/label>\n        <div id=\"cid_26\" 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_26_0\" name=\"q26_input26[]\" value=\"Click here if your mailing address is different to the Supply Address\" \/>\n              <label id=\"label_input_26_0\" for=\"input_26_0\"> Click here if your mailing address is different to the Supply Address <\/label>\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line form-field-hidden\" style=\"display:none;\" data-type=\"control_text\" id=\"id_173\">\n        <div id=\"cid_173\" class=\"form-input-wide\">\n          <div id=\"text_173\" class=\"form-html\" data-component=\"text\">\n            <p><span style=\"font-size:12pt;\"><strong>Postal address<\/strong><\/span><\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line form-field-hidden\" style=\"display:none;\" data-type=\"control_textbox\" id=\"id_177\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_177\" for=\"input_177\"> PO Box \/ Flat \/ Unit number <\/label>\n        <div id=\"cid_177\" class=\"form-input\">\n          <input type=\"text\" id=\"input_177\" name=\"q177_poBox\" data-type=\"input-textbox\" class=\"form-textbox\" size=\"6\" value=\"\" placeholder=\" \" data-component=\"textbox\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line form-field-hidden\" style=\"display:none;\" data-type=\"control_textbox\" id=\"id_179\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_179\" for=\"input_179\"> Street number <\/label>\n        <div id=\"cid_179\" class=\"form-input\">\n          <input type=\"text\" id=\"input_179\" name=\"q179_streetNumber\" data-type=\"input-textbox\" class=\"form-textbox\" size=\"6\" value=\"\" placeholder=\" \" data-component=\"textbox\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line form-field-hidden\" style=\"display:none;\" data-type=\"control_textbox\" id=\"id_169\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_169\" for=\"input_169\"> Street name and type <\/label>\n        <div id=\"cid_169\" class=\"form-input\">\n          <input type=\"text\" id=\"input_169\" name=\"q169_streetName169\" data-type=\"input-textbox\" class=\"form-textbox\" size=\"20\" value=\"\" placeholder=\" \" data-component=\"textbox\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required form-field-hidden\" style=\"display:none;\" data-type=\"control_textbox\" id=\"id_170\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_170\" for=\"input_170\">\n          Suburb\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_170\" class=\"form-input jf-required\">\n          <input type=\"text\" id=\"input_170\" name=\"q170_suburb170\" data-type=\"input-textbox\" class=\"form-textbox validate[required]\" size=\"20\" value=\"\" placeholder=\" \" data-component=\"textbox\" required=\"\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required form-field-hidden\" style=\"display:none;\" data-type=\"control_dropdown\" id=\"id_171\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_171\" for=\"input_171\">\n          State\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_171\" class=\"form-input jf-required\">\n          <select class=\"form-dropdown validate[required]\" id=\"input_171\" name=\"q171_state171\" style=\"width:150px;\" data-component=\"dropdown\" required=\"\">\n            <option value=\"\">  <\/option>\n            <option value=\"NSW\"> NSW <\/option>\n            <option value=\"QLD\"> QLD <\/option>\n            <option value=\"SA\"> SA <\/option>\n            <option value=\"VIC\"> VIC <\/option>\n            <option value=\"ACT\"> ACT <\/option>\n          <\/select>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required form-field-hidden\" style=\"display:none;\" data-type=\"control_textbox\" id=\"id_172\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_172\" for=\"input_172\">\n          Postcode\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_172\" class=\"form-input jf-required\">\n          <input type=\"text\" id=\"input_172\" name=\"q172_postcode172\" data-type=\"input-textbox\" class=\"form-textbox validate[required, Numeric]\" size=\"20\" value=\"\" placeholder=\" \" data-component=\"textbox\" required=\"\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_checkbox\" id=\"id_141\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_141\" for=\"input_141_0\">\n          Is your electricity meter accessible?\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_141\" class=\"form-input 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]\" id=\"input_141_0\" name=\"q141_isYour141[]\" value=\"Yes\" required=\"\" \/>\n              <label id=\"label_input_141_0\" for=\"input_141_0\"> Yes <\/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]\" id=\"input_141_1\" name=\"q141_isYour141[]\" value=\"No, there are access issues\" required=\"\" \/>\n              <label id=\"label_input_141_1\" for=\"input_141_1\"> No, there are access issues <\/label>\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line form-field-hidden\" style=\"display:none;\" data-type=\"control_textbox\" id=\"id_64\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_64\" for=\"input_64\"> What are your meter access issues and how do we manage them? <\/label>\n        <div id=\"cid_64\" class=\"form-input\">\n          <input type=\"text\" id=\"input_64\" name=\"q64_whatAre64\" data-type=\"input-textbox\" class=\"form-textbox\" size=\"60\" value=\"\" placeholder=\"eg: locked gate which will be left unlocked\" data-component=\"textbox\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_textbox\" id=\"id_52\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_52\" for=\"input_52\"> NMI number <\/label>\n        <div id=\"cid_52\" class=\"form-input\">\n          <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n            <input type=\"text\" id=\"input_52\" name=\"q52_nmiNumber52\" data-type=\"input-textbox\" class=\"form-textbox\" size=\"20\" value=\"\" maxlength=\"11\" placeholder=\" \" data-component=\"textbox\" \/>\n            <label class=\"form-sub-label\" for=\"input_52\" style=\"min-height:13px;\"> This is your National Meter Identifier number found on your electricity bills. Helpful but not mandatory. <\/label>\n          <\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line form-field-hidden\" style=\"display:none;\" data-type=\"control_textbox\" id=\"id_54\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_54\" for=\"input_54\"> Business name <\/label>\n        <div id=\"cid_54\" class=\"form-input\">\n          <input type=\"text\" id=\"input_54\" name=\"q54_businessName\" data-type=\"input-textbox\" class=\"form-textbox\" size=\"20\" value=\"\" placeholder=\" \" data-component=\"textbox\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line form-field-hidden\" style=\"display:none;\" data-type=\"control_textbox\" id=\"id_53\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_53\" for=\"input_53\"> Business ACN\/ABN <\/label>\n        <div id=\"cid_53\" class=\"form-input\">\n          <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n            <input type=\"text\" id=\"input_53\" name=\"q53_businessAcnabn53\" data-type=\"input-textbox\" class=\"form-textbox\" size=\"20\" value=\"\" placeholder=\" \" data-component=\"textbox\" \/>\n            <label class=\"form-sub-label\" for=\"input_53\" style=\"min-height:13px;\"> Please refrain from using spaces or hyphens <\/label>\n          <\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_checkbox\" id=\"id_156\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_156\" for=\"input_156_0\">\n          Do you have a solar system?\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_156\" class=\"form-input 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]\" id=\"input_156_0\" name=\"q156_doYou[]\" value=\"Yes\" required=\"\" \/>\n              <label id=\"label_input_156_0\" for=\"input_156_0\"> Yes <\/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]\" id=\"input_156_1\" name=\"q156_doYou[]\" value=\"I am in the process of installing solar\" required=\"\" \/>\n              <label id=\"label_input_156_1\" for=\"input_156_1\"> I am in the process of installing solar <\/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]\" id=\"input_156_2\" name=\"q156_doYou[]\" value=\"No\" required=\"\" \/>\n              <label id=\"label_input_156_2\" for=\"input_156_2\"> No <\/label>\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line form-field-hidden\" style=\"display:none;\" data-type=\"control_textbox\" id=\"id_157\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_157\" for=\"input_157\"> Solar system installer <\/label>\n        <div id=\"cid_157\" class=\"form-input\">\n          <input type=\"text\" id=\"input_157\" name=\"q157_solarSystem\" data-type=\"input-textbox\" class=\"form-textbox\" size=\"50\" value=\"\" placeholder=\" \" data-component=\"textbox\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line form-field-hidden\" style=\"display:none;\" data-type=\"control_dropdown\" id=\"id_158\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_158\" for=\"input_158\"> Solar panel manufacturer <\/label>\n        <div id=\"cid_158\" class=\"form-input\">\n          <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n            <select class=\"form-dropdown\" id=\"input_158\" name=\"q158_solarPanel\" style=\"width:150px;\" data-component=\"dropdown\">\n              <option value=\"\"> please select <\/option>\n              <option value=\"Bosch\"> Bosch <\/option>\n              <option value=\"BP SunOasis\"> BP SunOasis <\/option>\n              <option value=\"Canadian Solar\"> Canadian Solar <\/option>\n              <option value=\"Csun Solar\"> Csun Solar <\/option>\n              <option value=\"Hanwha Solar\"> Hanwha Solar <\/option>\n              <option value=\"REC\"> REC <\/option>\n              <option value=\"Renesola\"> Renesola <\/option>\n              <option value=\"Simax Solar\"> Simax Solar <\/option>\n              <option value=\"Solar World\"> Solar World <\/option>\n              <option value=\"Sun-Earth Solar\"> Sun-Earth Solar <\/option>\n              <option value=\"SunPower\"> SunPower <\/option>\n              <option value=\"Suntech\"> Suntech <\/option>\n              <option value=\"Tindo Solar\"> Tindo Solar <\/option>\n              <option value=\"Trina Solar\"> Trina Solar <\/option>\n              <option value=\"Yingli Solar\"> Yingli Solar <\/option>\n              <option value=\"Other(enter details below)\"> Other(enter details below) <\/option>\n            <\/select>\n            <label class=\"form-sub-label\" for=\"input_158\" style=\"min-height:13px;\"> (If known) <\/label>\n          <\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line form-field-hidden\" style=\"display:none;\" data-type=\"control_textbox\" id=\"id_159\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_159\" for=\"input_159\"> Other <\/label>\n        <div id=\"cid_159\" class=\"form-input\">\n          <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n            <input type=\"text\" id=\"input_159\" name=\"q159_other\" data-type=\"input-textbox\" class=\"form-textbox\" size=\"50\" value=\"\" placeholder=\" \" data-component=\"textbox\" \/>\n            <label class=\"form-sub-label\" for=\"input_159\" style=\"min-height:13px;\"> If your solar panel manufacturer is not in the above list please enter here <\/label>\n          <\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line form-field-hidden\" style=\"display:none;\" data-type=\"control_number\" id=\"id_162\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_162\" for=\"input_162\"> Solar system capacity kW <\/label>\n        <div id=\"cid_162\" class=\"form-input\">\n          <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n            <input type=\"number\" id=\"input_162\" name=\"q162_solarSystem162\" data-type=\"input-number\" class=\" form-number-input form-textbox\" style=\"width:60px;\" size=\"5\" value=\"\" placeholder=\"eg: 2.5\" data-component=\"number\" \/>\n            <label class=\"form-sub-label\" for=\"input_162\" style=\"min-height:13px;\"> Please enter capacity in kiloWatts (kW) (1kW = 1000 Watts) <\/label>\n          <\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line form-field-hidden\" style=\"display:none;\" data-type=\"control_text\" id=\"id_161\">\n        <div id=\"cid_161\" class=\"form-input-wide\">\n          <div id=\"text_161\" class=\"form-html\" data-component=\"text\">\n            <p><span style=\"color:#ff0000;\">You have selected a fairly large solar system size (greater than 50 kW), please check the size you have entered is correct. If you are unsure you can count your solar panels, usually there are 4 solar panels to 1 kW.\u00a0<\/span><\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line form-field-hidden\" style=\"display:none;\" data-type=\"control_datetime\" id=\"id_163\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_163\" for=\"day_163\"> Solar installation date <\/label>\n        <div id=\"cid_163\" class=\"form-input\">\n          <div data-wrapper-react=\"true\">\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n              <input class=\"form-textbox validate[limitDate]\" id=\"day_163\" name=\"q163_solarInstallation[day]\" type=\"tel\" size=\"2\" data-maxlength=\"2\" value=\"\" \/>\n              <span class=\"date-separate\">\n                \u00a0-\n              <\/span>\n              <label class=\"form-sub-label\" for=\"day_163\" 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[limitDate]\" id=\"month_163\" name=\"q163_solarInstallation[month]\" type=\"tel\" size=\"2\" data-maxlength=\"2\" value=\"\" \/>\n              <span class=\"date-separate\">\n                \u00a0-\n              <\/span>\n              <label class=\"form-sub-label\" for=\"month_163\" 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[limitDate]\" id=\"year_163\" name=\"q163_solarInstallation[year]\" type=\"tel\" size=\"4\" data-maxlength=\"4\" value=\"\" \/>\n              <label class=\"form-sub-label\" for=\"year_163\" 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_163_pick\" src=\"https:\/\/cdn.jotfor.ms\/images\/calendar.png\" style=\"vertical-align:middle;\" data-component=\"datetime\" \/>\n              <label class=\"form-sub-label\" for=\"input_163_pick\" style=\"min-height:13px;\">  <\/label>\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line form-field-hidden\" style=\"display:none;\" data-type=\"control_dropdown\" id=\"id_164\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_164\" for=\"input_164\"> Do you receive a govt regulated feed-in tariff (existing solar only)? <\/label>\n        <div id=\"cid_164\" class=\"form-input\">\n          <select class=\"form-dropdown\" id=\"input_164\" name=\"q164_doYou164\" style=\"width:150px;\" data-component=\"dropdown\">\n            <option value=\"\">  <\/option>\n            <option value=\"QLD 44 cents\/net kWh\"> QLD 44 cents\/net kWh <\/option>\n            <option value=\"SA 44 cents\/net kWh\"> SA 44 cents\/net kWh <\/option>\n            <option value=\"SA 44 cents\/net kWh (1st 45kWh\/d)\"> SA 44 cents\/net kWh (1st 45kWh\/d) <\/option>\n            <option value=\"VIC 60 cents\/net kWh (PFIT)\"> VIC 60 cents\/net kWh (PFIT) <\/option>\n            <option value=\"other (or not sure)\"> other (or not sure) <\/option>\n            <option value=\"not applicable\"> not applicable <\/option>\n          <\/select>\n        <\/div>\n      <\/li>\n      <li id=\"cid_57\" 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_57\" 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_57\" 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_57\">\n          <\/div>\n        <\/div>\n      <\/li>\n    <\/ul>\n    <ul class=\"form-section page-section\" style=\"display:none;\">\n      <li id=\"cid_166\" 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_166\" class=\"form-header\" data-component=\"header\">\n              Step 3: Other Details\n            <\/h2>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_text\" id=\"id_103\">\n        <div id=\"cid_103\" class=\"form-input-wide\">\n          <div id=\"text_103\" class=\"form-html\" data-component=\"text\">\n            <p><span style=\"font-size:10pt;\"><strong>Direct debit payment method<\/strong> - the\u00a0easy hassle free payment method. You will receive your bill and 14 days later we\u00a0will process your invoice total via your nominated bank account or credit card - it's effortless!<\/span><\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_checkbox\" id=\"id_105\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_105\" for=\"input_105_0\"> To proceed with Direct Debit payment method choose one of the following: <\/label>\n        <div id=\"cid_105\" 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_105_0\" name=\"q105_toProceed[]\" value=\"Debit my invoice from my bank account\" \/>\n              <label id=\"label_input_105_0\" for=\"input_105_0\"> Debit my invoice from my bank account <\/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_105_1\" name=\"q105_toProceed[]\" value=\"Debit my invoice total from my credit card\" \/>\n              <label id=\"label_input_105_1\" for=\"input_105_1\"> Debit my invoice total from my credit card <\/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_105_2\" name=\"q105_toProceed[]\" value=\"Debit\/credit (as applicable) my invoice total from\/to my bank account\" \/>\n              <label id=\"label_input_105_2\" for=\"input_105_2\"> Debit\/credit (as applicable) my invoice total from\/to my bank account <\/label>\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line form-field-hidden\" style=\"display:none;\" data-type=\"control_text\" id=\"id_106\">\n        <div id=\"cid_106\" class=\"form-input-wide\">\n          <div id=\"text_106\" class=\"form-html\" data-component=\"text\">\n            <p><span style=\"font-size: 12pt;\"><strong>Bank Account Details<\/strong><\/span><\/p>\n            <p>If you would like us to debit your invoice total from your bank account, please enter your bank account details below. <\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required form-field-hidden\" style=\"display:none;\" data-type=\"control_textbox\" id=\"id_107\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_107\" for=\"input_107\">\n          Financial Institution\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_107\" class=\"form-input jf-required\">\n          <input type=\"text\" id=\"input_107\" name=\"q107_financialInstitution\" data-type=\"input-textbox\" class=\"form-textbox validate[required]\" size=\"20\" value=\"\" maxlength=\"50\" placeholder=\" \" data-component=\"textbox\" required=\"\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required form-field-hidden\" style=\"display:none;\" data-type=\"control_textbox\" id=\"id_108\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_108\" for=\"input_108\">\n          Account Holder\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_108\" class=\"form-input jf-required\">\n          <input type=\"text\" id=\"input_108\" name=\"q108_accountHolder\" data-type=\"input-textbox\" class=\"form-textbox validate[required]\" size=\"20\" value=\"\" maxlength=\"50\" placeholder=\" \" data-component=\"textbox\" required=\"\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line form-field-hidden\" style=\"display:none;\" data-type=\"control_textbox\" id=\"id_109\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_109\" for=\"input_109\"> Branch Address <\/label>\n        <div id=\"cid_109\" class=\"form-input\">\n          <input type=\"text\" id=\"input_109\" name=\"q109_branchAddress\" data-type=\"input-textbox\" class=\"form-textbox\" size=\"20\" value=\"\" maxlength=\"50\" placeholder=\" \" data-component=\"textbox\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required form-field-hidden\" style=\"display:none;\" data-type=\"control_textbox\" id=\"id_110\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_110\" for=\"input_110\">\n          BSB\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_110\" class=\"form-input jf-required\">\n          <input type=\"text\" id=\"input_110\" name=\"q110_bsb\" data-type=\"input-textbox\" class=\"form-textbox validate[required, Numeric]\" size=\"6\" value=\"\" maxlength=\"6\" placeholder=\" \" data-component=\"textbox\" required=\"\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required form-field-hidden\" style=\"display:none;\" data-type=\"control_textbox\" id=\"id_111\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_111\" for=\"input_111\">\n          Account Number\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_111\" class=\"form-input jf-required\">\n          <input type=\"text\" id=\"input_111\" name=\"q111_accountNumber\" data-type=\"input-textbox\" class=\"form-textbox validate[required, Numeric]\" size=\"20\" value=\"\" placeholder=\" \" data-component=\"textbox\" required=\"\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line form-field-hidden\" style=\"display:none;\" data-type=\"control_text\" id=\"id_112\">\n        <div id=\"cid_112\" class=\"form-input-wide\">\n          <div id=\"text_112\" class=\"form-html\" data-component=\"text\">\n            <p><span style=\"font-size: 12pt;\"><strong>Credit Card Details<\/strong><\/span><\/p>\n            <p>If you would like us to debit your invoice total from your credit card, please enter one below.<br \/><br \/>We accept Mastercard or Visa, but not AMEX. A surcharge may apply for Credit Card payments.<\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required form-field-hidden\" style=\"display:none;\" data-type=\"control_textbox\" id=\"id_113\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_113\" for=\"input_113\">\n          Name on card\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_113\" class=\"form-input jf-required\">\n          <input type=\"text\" id=\"input_113\" name=\"q113_nameOn\" data-type=\"input-textbox\" class=\"form-textbox validate[required]\" size=\"20\" value=\"\" maxlength=\"50\" placeholder=\" \" data-component=\"textbox\" required=\"\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required form-field-hidden\" style=\"display:none;\" data-type=\"control_textbox\" id=\"id_114\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_114\" for=\"input_114\">\n          Credit Card number\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_114\" class=\"form-input jf-required\">\n          <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n            <input type=\"text\" id=\"input_114\" name=\"q114_creditCard114\" data-type=\"input-textbox\" class=\"form-textbox validate[required, Numeric]\" size=\"20\" value=\"\" maxlength=\"20\" placeholder=\"eg:1234123412341234\" data-component=\"textbox\" required=\"\" \/>\n            <label class=\"form-sub-label\" for=\"input_114\" style=\"min-height:13px;\"> Typically a 16 digit number on your credit card, no space or hyphens please <\/label>\n          <\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required form-field-hidden\" style=\"display:none;\" data-type=\"control_dropdown\" id=\"id_122\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_122\" for=\"input_122\">\n          Card expiry month\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_122\" class=\"form-input jf-required\">\n          <select class=\"form-dropdown validate[required]\" id=\"input_122\" name=\"q122_cardExpiry122\" style=\"width:150px;\" data-component=\"dropdown\" required=\"\">\n            <option value=\"\">  <\/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        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required form-field-hidden\" style=\"display:none;\" data-type=\"control_dropdown\" id=\"id_124\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_124\" for=\"input_124\">\n          Card expiry year\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_124\" class=\"form-input jf-required\">\n          <select class=\"form-dropdown validate[required]\" id=\"input_124\" name=\"q124_cardExpiry\" style=\"width:150px;\" data-component=\"dropdown\" required=\"\">\n            <option value=\"\">  <\/option>\n            <option value=\"2016\"> 2016 <\/option>\n            <option value=\"2017\"> 2017 <\/option>\n            <option value=\"2018\"> 2018 <\/option>\n            <option value=\"2019\"> 2019 <\/option>\n            <option value=\"2020\"> 2020 <\/option>\n            <option value=\"2021\"> 2021 <\/option>\n            <option value=\"2022\"> 2022 <\/option>\n            <option value=\"2023\"> 2023 <\/option>\n            <option value=\"2024\"> 2024 <\/option>\n            <option value=\"2025\"> 2025 <\/option>\n            <option value=\"2026\"> 2026 <\/option>\n          <\/select>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required form-field-hidden\" style=\"display:none;\" data-type=\"control_textbox\" id=\"id_117\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_117\" for=\"input_117\">\n          CCV number\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_117\" class=\"form-input jf-required\">\n          <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n            <input type=\"text\" id=\"input_117\" name=\"q117_ccvNumber\" data-type=\"input-textbox\" class=\"form-textbox validate[required, AlphaNumeric]\" size=\"4\" value=\"\" maxlength=\"5\" placeholder=\" \" data-component=\"textbox\" required=\"\" \/>\n            <label class=\"form-sub-label\" for=\"input_117\" style=\"min-height:13px;\"> 3 digit number on back of card <\/label>\n          <\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_dropdown\" id=\"id_180\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_180\" for=\"input_180\"> Interested in GreenPower? <\/label>\n        <div id=\"cid_180\" class=\"form-input\">\n          <select class=\"form-dropdown\" id=\"input_180\" name=\"q180_interestedIn\" style=\"width:200px;\" data-component=\"dropdown\">\n            <option value=\"\">  <\/option>\n            <option value=\"100%\"> 100% <\/option>\n            <option value=\"50%\"> 50% <\/option>\n            <option value=\"20%\"> 20% <\/option>\n            <option value=\"Please email more information\"> Please email more information <\/option>\n          <\/select>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_checkbox\" id=\"id_34\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_34\" for=\"input_34_0\"> Are you a concession card holder? <\/label>\n        <div id=\"cid_34\" class=\"form-input\">\n          <div class=\"form-multiple-column\" data-columncount=\"2\" data-component=\"checkbox\">\n            <span class=\"form-checkbox-item\">\n              <span class=\"dragger-item\">\n              <\/span>\n              <input type=\"checkbox\" class=\"form-checkbox\" id=\"input_34_0\" name=\"q34_areYou34[]\" value=\"Yes\" \/>\n              <label id=\"label_input_34_0\" for=\"input_34_0\"> Yes <\/label>\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_checkbox\" id=\"id_35\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_35\" for=\"input_35_0\"> Do you have powered life support equipment? <\/label>\n        <div id=\"cid_35\" class=\"form-input\">\n          <div class=\"form-multiple-column\" data-columncount=\"2\" data-component=\"checkbox\">\n            <span class=\"form-checkbox-item\">\n              <span class=\"dragger-item\">\n              <\/span>\n              <input type=\"checkbox\" class=\"form-checkbox\" id=\"input_35_0\" name=\"q35_lifeSupport35[]\" value=\"Yes\" \/>\n              <label id=\"label_input_35_0\" for=\"input_35_0\"> Yes <\/label>\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_textbox\" id=\"id_144\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_144\" for=\"input_144\"> Promotional code <\/label>\n        <div id=\"cid_144\" class=\"form-input\">\n          <input type=\"text\" id=\"input_144\" name=\"q144_promotionalCode\" data-type=\"input-textbox\" class=\"form-textbox\" size=\"20\" value=\"\" placeholder=\"eg. referral\" data-component=\"textbox\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_dropdown\" id=\"id_63\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_63\" for=\"input_63\"> Who is your current electricity retailer <\/label>\n        <div id=\"cid_63\" class=\"form-input\">\n          <select class=\"form-dropdown\" id=\"input_63\" name=\"q63_whoIs63\" style=\"width:150px;\" data-component=\"dropdown\">\n            <option value=\"\">  <\/option>\n            <option value=\"AGL\"> AGL <\/option>\n            <option value=\"ActewAGL\"> ActewAGL <\/option>\n            <option value=\"Australia Power &amp; Gas\"> Australia Power &amp; Gas <\/option>\n            <option value=\"Click\"> Click <\/option>\n            <option value=\"Dodo\"> Dodo <\/option>\n            <option value=\"Energy Australia\"> Energy Australia <\/option>\n            <option value=\"Ergon Energy\"> Ergon Energy <\/option>\n            <option value=\"ERM\"> ERM <\/option>\n            <option value=\"Lumo\"> Lumo <\/option>\n            <option value=\"Momentum\"> Momentum <\/option>\n            <option value=\"Origin Energy\"> Origin Energy <\/option>\n            <option value=\"PowerDirect\"> PowerDirect <\/option>\n            <option value=\"QEnergy\"> QEnergy <\/option>\n            <option value=\"Red Energy\"> Red Energy <\/option>\n            <option value=\"Sanctuary Energy\"> Sanctuary Energy <\/option>\n            <option value=\"Simply Energy\"> Simply Energy <\/option>\n            <option value=\"Other\"> Other <\/option>\n          <\/select>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_checkbox\" id=\"id_125\">\n        <label class=\"form-label form-label-left\" id=\"label_125\" for=\"input_125_0\"> Would you like to receive updates on our promotions? <\/label>\n        <div id=\"cid_125\" 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_125_0\" name=\"q125_wouldYou[]\" checked=\"\" value=\"Yes\" \/>\n              <label id=\"label_input_125_0\" for=\"input_125_0\"> Yes <\/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_125_1\" name=\"q125_wouldYou[]\" value=\"No\" \/>\n              <label id=\"label_input_125_1\" for=\"input_125_1\"> No <\/label>\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_textarea\" id=\"id_32\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_32\" for=\"input_32\"> Any other comments? <\/label>\n        <div id=\"cid_32\" class=\"form-input\">\n          <textarea id=\"input_32\" class=\"form-textarea\" name=\"q32_anyOther\" cols=\"45\" rows=\"6\" data-component=\"textarea\"><\/textarea>\n        <\/div>\n      <\/li>\n      <li id=\"cid_58\" 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_58\" 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_58\" 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_58\">\n          <\/div>\n        <\/div>\n      <\/li>\n    <\/ul>\n    <ul class=\"form-section page-section\" style=\"display:none;\">\n      <li id=\"cid_49\" class=\"form-input-wide\" data-type=\"control_head\">\n        <div class=\"form-header-group \">\n          <div class=\"header-text httal htvam\">\n            <h3 id=\"header_49\" class=\"form-header\" data-component=\"header\">\n              Step 4: Confirmation\n            <\/h3>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_text\" id=\"id_174\">\n        <div id=\"cid_174\" class=\"form-input-wide\">\n          <div id=\"text_174\" class=\"form-html\" data-component=\"text\">\n            <p>By clicking Sign Up below, I understand that:<\/p>\n            <p>1. Diamond Energy will review the information I have provided in this online application which forms my Retail Supply Agreement, my tariff and metering details and advise me of any changes in the relevant Charges as appropriate or contact me if further information is required;<\/p>\n            <p>2. Charges (including the amount and structure of any Charge), discounts, Feed-in Rates and Terms and Conditions may be varied from time to time and I will be notified in accordance with the Terms and Conditions;\u00a0<\/p>\n            <p>3. I am entering into an Agreement with Diamond Energy which includes the relevant Terms and Important Information in relation to the Supply Address, which will be emailed to me in a Welcome Pack shortly; and<\/p>\n            <p>4. Any right to a cooling off period will be included in my Welcome Pack.<\/p>\n            <p>I confirm that I am authorised to enter into this Agreement and I have read, understand and accept the terms of the Agreement and give my explicit informed consent.<\/p>\n            <p>If I have included my direct debit details:<\/p>\n            <p>1. I understand that Diamond Energy cannot make credit payments into a nominated credit card account. I also understand that if I am nominating a joint account for direct debit payments, authorisation and proof of authority may be required from each joint account holder;<\/p>\n            <p>2. I authorise Diamond Energy to verify the details of my account with my Financial Institution and I authorize my nominated Financial Institution to release information to Diamond Energy to verify the account details; and<\/p>\n            <p>3. I consent Diamond Energy Retail Pty Ltd (User Identification number 419899) to direct debit my nominated account through the Bulk Electronic Clearing System, in accordance with Direct Debit Terms &amp; Conditions until further notice.<\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_captcha\" id=\"id_51\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_51\" for=\"input_51\">\n          Please enter the text as shown in the box\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_51\" class=\"form-input jf-required\">\n          <div class=\"form-captcha\" data-component=\"captcha\">\n            <label for=\"input_51\"> <img alt=\"Captcha - Reload if not displayed\" id=\"input_51_captcha\" class=\"form-captcha-image\" style=\"background:url(https:\/\/cdn.jotfor.ms\/images\/loader-big.gif) no-repeat center;\" src=\"https:\/\/cdn.jotfor.ms\/images\/blank.gif\" width=\"150\" height=\"41\" \/> <\/label>\n            <div style=\"white-space:nowrap;\">\n              <input type=\"text\" id=\"input_51\" class=\"form-textbox validate[required]\" name=\"captcha\" style=\"width:130px;\" required=\"\" \/>\n              <img src=\"https:\/\/cdn.jotfor.ms\/images\/reload.png\" alt=\"Reload\" style=\"cursor:pointer;vertical-align:middle;\" id=\"input_51_reload\" \/>\n              <input type=\"hidden\" name=\"captcha_id\" id=\"input_51_captcha_id\" value=\"0\" \/>\n            <\/div>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_widget\" id=\"id_77\">\n        <div id=\"cid_77\" class=\"\">\n          <div style=\"width:100%;text-align:Left;\" data-component=\"widget-directEmbed\">\n            <div class=\"direct-embed-widgets \" data-type=\"direct-embed\" style=\"width:50px;height:50px;\">\n              <div class=\"google_analytics_widget\">\n                <script>\n                            (function(i, s, o, g, r, a, m)\n            {\n              i['GoogleAnalyticsObject'] = r;\n              i[r] = i[r] ||\n              function()\n              {\n                (i[r].q = i[r].q || []).push(arguments)\n              }, i[r].l = 1 * new Date();\n              a = s.createElement(o), m = s.getElementsByTagName(o)[0];\n              a.async = 1;\n              a.src = g;\n              m.parentNode.insertBefore(a, m)\n            })(window, document, 'script', '\/\/www.google-analytics.com\/analytics.js', 'ga');\n\n            ga('create', 'UA-40631941-2', 'auto');\n            ga('send', 'pageview');\n                <\/script>\n                <script src=\"\/\/widgets.jotform.io\/googleanalytics\/scripts.js?1\" type=\"text\/javascript\"><\/script>\n              <\/div>\n            <\/div>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_button\" id=\"id_45\">\n        <div id=\"cid_45\" class=\"form-input-wide\">\n          <div style=\"text-align:center;\" class=\"form-buttons-wrapper\">\n            <button id=\"input_45\" type=\"submit\" class=\"form-submit-button form-submit-button-simple_green_apple\" data-component=\"button\">\n              Sign up\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=\"53489089313868\" \/>\n  <script type=\"text\/javascript\">\n  document.getElementById(\"si\" + \"mple\" + \"_spc\").value = \"53489089313868-53489089313868\";\n  <\/script>\n  <script src=\"https:\/\/cdn.jotfor.ms\/js\/widgetResizer.js?REV=3.3.4791\" type=\"text\/javascript\"><\/script>\n<\/form><\/body>\n<\/html>\n","Sign up V4",Array,0);(function(){window.handleIFrameMessage=function(e){if(!e.data||!e.data.split)return;var args=e.data.split(":");var iframe=document.getElementById("53489089313868");if(!iframe){return};switch(args[0]){case"scrollIntoView":if(!("nojump"in FrameBuilder.get)){iframe.scrollIntoView();}
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