Move In Application Form

Complete and submit the application form.

Please fill out the application form below or click here to fill it in manually and mail it to us.

Personal Details

Select one of the two following options regarding payment of your $30.00 (incl GST) application and administration fee (see pricing conditions at bottom of terms & conditions).

Payment Instructions
Cheque for $30.00 - Sent to Energyco New Zealand Limited, PO Box 12178, Penrose, AUCKLAND 1642. Payable to Energyco Ltd
Added to first account - agree to have the fee of $30 added to your first account

Owner
Tenant

Yes
No

Yes
No

Declaration

By submitting this application form, you confirm that the above particulars are true. You understand that we may use the information that you have provided to us for the purpose of deciding whether or not to accept your application and for purposes relating to the ongoing relationship between you and Energyco Limited (including debt recovery). You authorize us to use this information for these purposes and also to disclose it to any referee who you nominate and also to any credit reference agency we may approach. If you do not supply us with this information, which we request, we may be unable to adequately assess your financial standing, and may decline this application. We may also disclose your information to a third party to the extent required to facilitate hot water supply to you including to the operator of any gas network. You also authorize any such referee or credit reference agency to provide us with information, which we may require in order to assess your financial standing.

You have the right to request access to and correction of personal information, which we hold about you.

You acknowledge that you have read our Terms of Agreement and Pricing List on the reverse of this Application Form and agree to be bound by the terms and conditions.

I have read and accepted the declaration & terms and conditions*