First Name * Surname * Address of property requiring LPG * Country * New Zealand Address 1 * Address 2 Town/City * Postcode * Postal address (if different to above) Address 1 Address 2 Town/City Postcode Phone number * Mobile number Email address * Do you own the property? * Yes No If renting, please include landlord's name, address and contact phone number What will the LPG be used for? Cooking Water Heating Space Heating Outdoor Heating I have read and agree to Rockgas Hawkes Bay Terms and Conditions of Residential Energy Supply and confirm that I have provided correct and complete information where required. Special delivery instructions
First Name * Surname * Address of property requiring LPG * Country * New Zealand Address 1 * Address 2 Town/City * Postcode * Postal address (if different to above) Address 1 Address 2 Town/City Postcode Phone number * Mobile number Email address * Do you own the property? * Yes No If renting, please include landlord's name, address and contact phone number What will the LPG be used for? Cooking Water Heating Space Heating Outdoor Heating I have read and agree to Rockgas Hawkes Bay Terms and Conditions of Residential Energy Supply and confirm that I have provided correct and complete information where required. Special delivery instructions
