Residential LPG Application - South Island

Please complete the details below. alternatively print a copy of the application form and mail or fax it to us, if you have any questions about filling in this form please contact our customer care team on 0800 668 236.

Printable application form (PDF file)

Once your application is approved we will contact you confirm your details and arrange your initial delivery. You should receive your first account from Nova Energy within six weeks and we will contact you if we require any further information from you. Your energy will be supplied under Nova Energy’s Standard LPG Residential Terms of Supply and fees may apply.

Are you currently or have you ever been a Nova Energy customer?: *

Yes

Details of Person/s registering

Applicant 1 - first name: *

Applicant 1 - middle name:

Applicant 1 - surname: *

Applicant 1 - date of birth: *

Applicant 2 - first name:

Applicant 2 - middle name:

Applicant 2 - surname:

Applicant 2 - date of birth:

Daytime phone: *

Evening phone: *

Mobile:

Email address: *

Would you like to have your monthly invoice sent by email?: *

Yes

If you select this option you will not receive a copy of your invoice by post.

Date for supply to start: *

Please note: applications received with a weekend start date will be scheduled for the first available delivery date for your area.

Physical Address - property to be supplied

Street number: *

Flat number:

Street name: *

Suburb:

City/Town: *

Post code: *

Please enter your 4 digit post code, if you don't know your post code you can look it up on the NZ Post website.

Postal Address - if different from above

PO Box/Private Bag:

Street number:

Street name:

Suburb:

City/Town:

Post code:

Alternative contact person's name (not at same address):

Alternative contact's address:

Alternative contact's phone number:

Are you the property owner?: *

Yes

No - if no the next section must be completed

Landlord/Property manager's name:

Landlord/Property manager's address:

Landlord/Property managers's phone number:

Size of cylinders required: *

Number of cylinders required: *

Location of cylinders:

ie. outside down the right-hand side of house

Installation details (if a new installation) - name and phone number of gasfitter:

What do you use LPG for?:

Heating

Cooking

Hot water

Do we require a key for access?:

Yes

Do you agree to Nova Energy carrying out a credit check?: *

Yes

No - if no or you fail our credit criteria - we will be unable to supply your LPG.

Would you like us to register you for an automatic payment?:

Yes

(Many customers choose to pay by Direct Debit or some other form of automatic payment as this can save time and hassle. It also ensures that your account is always paid on time.)

If "Yes" please specify::

Direct Debit

Automatic Payment

Tele-banking

Credit Card

Additional information:

Promotional code - if applicable:

I have read and agree to Nova Energy's Standard LPG Terms of Supply.

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