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The fields marked with * are mandatory for us to provide you a quote. Other questions are optional and might be used to offer different products and prices in the future. Please read our online privacy statement for further information.

 

 

Title	---Select--- Mr Mrs Ms Miss Dr Prof.
First name*
Surname*
Date of birth*
Connection address*
Suburb*
State*
Postcode*
Address where quote is to be sent to (if different from connection address)
Suburb
State	---Select--- ACT NSW NT QLD SA TAS VIC WA
Postcode
Daytime phone number*
Mobile phone number
Email address*

Current supplier*	Integral Energy Energy Australia AGL Country Energy Origin Energy Other
Account number
National Metering Identifier (NMI)
Consumption (Domestic) *	kWh Per Annum kWh Per Quarter
Do you have off-peak electricity?	No Yes If you have selected Yes please indicate your off-peak consumption.
Consumption (Off-Peak 1)	kWh Per Annum kWh Per Quarter
Consumption (Off-Peak 2)	kWh Per Annum kWh Per Quarter
Your Agreement Details
Agreement term *
Energy Products I would like a quote for the following energy product(s).
INgreen Living 10
INgreen Living 20
INgreen Living 50
INgreen Pure
INhome SmartSaver
INhome EasySaver
How did you hear about this offer*	Newspaper - Manly Daily Newspaper - Central Coast Advocate Newspaper - Newcastle Star Received promotional piece in the mail Integral Energy stand at event Other

What type is your home ?	House Unit / Townhouse
How many people live in your home?	1 2 3 4 5 6 7 8 9+
How many bedrooms are in your home?	1 2 3 4 5 6 7 8 9+
What type of hot water system do you use?	Electric Gas
Do you have an air-conditioner in your home?	Yes - reverse cycle Yes - cooling only No
Do you have a pool?	Yes No
Is your oven run by	Electricity Gas
Is your stove / cooktop run by	Electricity Gas