Account TypeWould you like this account to be billed to:*Please ChooseYour name onlyJoint names with someoneBusiness/Company/Trust nameWhat type of connection is this?*Please ChooseSwitching supplierGetting LPG system installedMoving into a property with existing LPG connectionsNew BuildSwitching from 9KG cylindersLandlord only account - for paying cylinder rental ONLYOtherIs this for residential or business usage?*Please ChooseResidential usageBusiness usageHow did you hear about us?*Please ChooseAdvertising (e.g radio, facebook, etc)Referral from friend, family or landlordReferral from gasfittervia Contact EnergyRockgas already supply this propertyPrevious Rockgas customerName of gasfitter or contractor organising installation* Other details* Business Name* Applicant DetailsName* First Middle Last Date of Birth* DD slash MM slash YYYY Mobile Number*Home Phone NumberEmail* Photo ID (Drivers License, Passport, etc)*Please ChooseI'll upload nowI'll send it later to sales@rockgastaranaki.co.nzAttach Photo ID*Max. file size: 128 MB.Max file size 2MB.Name (Second applicant)* First Middle Last Date of Birth (Second applicant)* DD slash MM slash YYYY Mobile Number (Second applicant)*Home Number (Second applicant)Email (Second applicant)* Photo ID (Second applicant)*Please ChooseI'll upload nowI'll send it later to admin@rockgastaranaki.co.nzAttach Photo ID (Second applicant)*Max. file size: 128 MB.Max file size 2MB.AddressAddress of property requiring LPG* City* Is your postal address different to the address above?* No Yes Postal Address Preferred first delivery dateI will advise date when first delivery is required* I'm waiting until my current cylinders are almost empty and I will contact Rockgas Taranaki closer to the time to place my first order. I would like to book my first delivery in for a specific date. New LPG installations or new builds - I will contact Rockgas Taranaki closer to the time when I have a confirmed date cylinders need to be on site. New LPG installations or new builds - I would like to book my first delivery in for a specific date. I have purchased/am moving into a new property please select your settlement/takeover date - please advise your settlement/takeover date. Date* DD slash MM slash YYYY Cylinder InformationWhat will LPG be primarily used for?* Hot water Cooking Heating Forklift Other Cylinder Size*Please Choose19kg15kg Forklift45kg (Standard House Bottle Size)Most standard installations are set up for 45KG cylinders. Why have you requested 19KG cylinders?* How many cylinders is your LPG installation set up for?*Please Choose12 (quantity for a standard house LPG installation)345678910Most standard LPG installations are set up to take 2 x LPG cylinders. What is the reason for only requesting one? Are there already cylinders at this property?*Please ChooseYesNoDon't knowWho are these cylinders supplied by?*Please ChooseRockgasGenesisOngasElgasOtherOther Supplier* Switching If you are switching suppliers: On our first delivery we will deliver two Rockgas cylinders and will remove the cylinders currently on site from your previous supplier. We organise for them to be returned to the previous supplier depot at no cost to you. Property DetailsIs there a Dog on-site?* Are there any site access issues that we need to be aware of ? Special delivery instructions for first delivery? Special delivery instructions for ongoing deliveries? Do you own the property?* Yes No Landlord Name Landlord Phone Number Landlord Email Landlord Address Would you like a comparative quote for your electricity from Contact?* Yes No Have you discussed with your landlord about them paying for the cylinder rental charges?* Yes - My landlord will be paying these charges No - I will be paying these charges For more information on gas bottle in relation to tenancy agreements please visit the following link: https://www.tenancy.govt.nz/rent-bond-and-bills/utilities-and-other-payments/How would you like to pay for the cylinder rental charges?* Yearly ($62.00 per cylinder per year) Monthly ($6.50 per cylinder per month) Cylinder rental charges are paid in advance. ICP Number* Your ICP number is found in the top right hand corner of your power bill.Credit Check* I authorise Rockgas Taranaki to obtain a Credit Check Terms & Conditions* Yes, I have read and agree to the Rockgas Terms & Conditions NameThis field is for validation purposes and should be left unchanged.
