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Your Company Name: *

Your Company ABN: *

Contact Details

Your Name: *

Your Position:

Phone Number: *

Fax Number:

Email Address: *

Buying Group Name or Referrer:

What is the Name of your Buying Group or How did you find out about us?

Estimated Spending: $ per year

Estimated Usage: kW per year

Your Current Supplier: *

Your Contract Expiry Date:

If already on a previous contestable market contract. Most will be N/A in the first year.

Your NMI Number: 8

from Bill generally found on Page 2 and in Tasmania starts with 8

Industry Type for this NMI:

Attach (PDF) copy of the detailed consumption page from a recent invoice for this NMI (Not the Payment page):

Attach (PDF) copy of your old Contracted Rates for this NMI, if on contract.:

Appointment of Tasmanian Energy Brokers: *

I hereby appoint Tasmanian Energy Brokers Pty Ltd

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