EarthFriendly Application

Congratulations on making the decision to sign-up for EarthFriendly. Just complete and submit this form and we'll take care of the rest.

* Indicates a mandatory field.

Your Details

Your Name*

Date of Birth*

Postal Address*

Phone (Home)*

Phone (Work)

Mobile

Email Address

Where did you hear about Earth Friendly?

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.

Nominated Percent* 100% 75% 50% 25%

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.synergyenergy.com.au/Residential_Segment/Green_Energy/Earth_Friendly_Application.html
Modified:	26/03/2008

Address:

http://www.synergyenergy.com.au/Residential_Segment/Green_Energy/Earth_Friendly_Application.html

Modified:

26/03/2008