Earth Friendly Application

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Congratulations on making the decision to signup your business for Earth Friendly. Just complete and submit this form and we’ll take care of the rest.

* Indicates a mandatory field.

Business Details

Business Name*

ACN (if applicable)

Postal Address*

Contact Person*

Phone*

Mobile

Email Address

Account Details

Account Number*

Number* Unit Lot Street

Street Name*

Suburb/Town*

Postcode*

Your Choice

Please choose the percentage of your electricity that you'd like to be Earth Friendly.

Percent Nominated * 100% 75% 50% 25% 10%

Authorisation Details

Agreed on behalf of (Business Name)*

Your Name*

Your Position*

Terms & Conditions

I understand that Earth Friendly will be charged to my account at 1.98 cents extra per unit* (inc GST).

When you submit this application, Earth Friendly will be applied to this account from the date of the last bill issued.

^*Prices subject to change.

Address:	http://www.synergy.net.au/Business_Segment/Green_Energy/Earth_Friendly_Application.html
Modified:	13/10/2006

Address:

http://www.synergy.net.au/Business_Segment/Green_Energy/Earth_Friendly_Application.html

Modified:

13/10/2006