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Request for Gas [Preliminary Notice]

Request for Gas Main Image

The meter box must be fitted in an approved position before submitting the Request for Gas form below.

For information regarding the processing of this form, please contact Alinta on 13 13 58.

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Please enter your details in the form below. Fields marked with * are mandatory.
A. ALINTA CUSTOMER ACCOUNT DETAILS
Account Number*
B. PROPERTY INFORMATION
Lot Number
Unit Number
House Number
Street*
Suburb *
Post Code *
State
Nearest Cross Street
Residential Installation* Yes    No
The dwelling is a* House    Unit    Villa    Townhouse    Duplex   
Is the property strata titled or does it share common ground? * Strata Titled    Share Common Ground    Other   
Number of Units/Villas/Townhouses
Requested Pressure* 1.25 KPA    2.75 KPA    Other KPA   
Is the distance from the front property boundary to the meter box more than 20 metres?*
Please note: Residential services over 20 metres will incur an additional charge 		Yes    No
Is the residential dwelling new or existing?* New    Existing
If the residential dwelling is new then what is the builders name?
If the residential dwelling is existing, is this connection an Emergency Change Over (ECO), ie. Hot Water System breakdown? Yes    No
Site Contact number
Date connection is required* / /
What number and type of gas appliances are being connected?
Storage Hot Water System      Quantity:     MJ/Hr: 
Continuous Hot Water System      Quantity:     MJ/Hr: 
Pool/Spa Heater      Quantity:     MJ/Hr: 
Cooktop/Oven      Quantity:     MJ/Hr: 
Ducted Heating      Quantity:     MJ/Hr: 
Flued Heating      Quantity:     MJ/Hr: 
Bayonet Point - Internal [Heater]      Quantity:     MJ/Hr: 
Bayonet Point - External [BBQ]      Quantity:     MJ/Hr: 
Other:      Quantity:     MJ/Hr: 
Is there a Type B appliance?* Yes    No
C. GAS FITTER INFORMATION
Gas Fitter Licence Number GF*
Gas Fitter Name*
Gas Fitter Company Name*
Gas Fitter Telephone*
Gas Fitter Email