Service Request Form

Part 1: Customer Details
Energy Company
If other please specify
First Name *required
Last Name
Mailing Address
City/Town
Post Code
Phone No. *required
Customer Email
Part 2: Site Address & Details
ICP No.
Street No.
 (Enter either Street No. or Lot & DP No. )
Lot & DP No.
 (Enter either Street No. or Lot & DP No. )
Street
Suburb
City/Town
Post Code
Date Livening Required Date Selector
Part 3: Electricians Details
Name
Company
Contact Phone No.
Email Address
Part 4: Connection Details
Connection Type
If other please specify
Relay
Relay
Network Connection
Phase
Amps
Network Connector
Part 5: Complete
Comments
Anti-Spam code (*required)
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Contact us
P : Phone:09 273 9132
E : Email: anne@sels.co.nz
 
A : Unit 17
14 Greenmount Drive
East Tamaki
Manukau
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