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Quotation Request Form (1) .pdf


Original filename: Quotation Request Form (1).pdf
Author: Niamh Kennedy

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Perth Energy Electricity & Gas Supply

REQUEST FOR QUOTATION FORM
PLEASE COMPLETE SECTION 1 CONTACT DETAILS
SECTION 2 FOR ELECTRICITY QUOTATION
SECTION 3 FOR GAS QUOTATION

SECTION 1 - CUSTOMER DETAILS

(Please complete in full in BLOCK CAPITALS):

*Company Name:
*Contact Name:
*Phone

ACN/ABN:

*Position:
*Email:

Current Retailer:

Spend per month (approx.): $

*Business Type:

Contract End Date (approx.):

SECTION 2 – ELECTRICITY QUOTATION
NMI

METER NUMBER

TARIFF

SUPPLY ADDRESS (AS SHOWN ON YOUR ELECTRICITY BILL)

DO YOU CURRENTLY HAVE SOLAR PV INSTALLED? IF YES

PLAN ON INSTALLING SOLAR PV IN THE FUTURE? IF YES

Array Size (kW):

Array Size (kW):

Inverter Size (kVA):

Inverter Size (kVA):

Install Date:

Install Date:

Installation Company:

SECTION 3 - GAS QUOTATION
Current Retailer:

Spend per month(approx.): $

Contract End Date (approx.):
MIRN (REQUIRED)

METER NUMBER (REQUIRED)

SUPPLY ADDRESS (AS SHOWN ON YOUR GAS BILL)

CUSTOMER COMMENTS:

Perth Energy requires permission from an authorised representative in order to obtain the gas and electricity consumption, profile and Contract
Maximum Demand (CMD) if applicable from ATCO or Western Power. By signing below, you are granting Perth Energy permission to obtain this
information.
PLEASE NOTE: This is NOT an application to supply energy to the business and there is no obligation or cost to receive a quote.

SIGN:
NAME (PLEASE PRINT)
POSITION:
FOR OFFICE USE ONLY:
PE MSO REF: ……………………

DATE:

Date Submitted: ……………………

Name: ……………………


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