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Customer details

First name

Last name

Phone

Email

Installation details

ICP No.

Customer Site Code/Order Number

Requested Date

Livening Date

Lot Number and/or Installation Address

Suburb/Town

City

Is the postal address the same as the installation address?

Yes No

Postal addr.

Meter info

Amps

Phases

1 2 3

Type

Underground Pillar Pit Overhead

Residential Business

Temporary Permanent Temporary to Permanent

Do you have controlled hot water?

Yes No

Electrician details

Business

Electrician

Mobile

Email

Inspector details

Name

Comments

Spark Connect

Would you like to have Ultrafast Broadband checked?

Yes No

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