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Domestic Application Form

Want to make Supagas your gas supplier? Simply complete an online application and one of our representatives will contact you shortly to arrange any gas requirements you may have. Alternatively you can visit your nearest branch or contact us on 13 78 72 to speak to one of our gas experts.

All Supagas customers are required to complete the new account application form.

Download Application Form (PDF) or apply online

 

* Required fields

Name & Surname:*
Date of Birth:
ABN (if applicable):
Delivery Address:*
Suburb:*
Postcode:*
State:
Postal Address:
Suburb:
Postcode:
State:
Premises: Rented Owned
Phone Number:*
Mobile Number:
Fax Number:
E-mail Address:*
Employer's Name:
Employer's Phone Number:
Work Address:
Suburb:
Postcode:
State:
Compliance Plate or Certificate No:
(For domestic LPG only)
Drivers Licence No:
Mode of Monthly Statement:  E-mail    Mail    Both
E-mail Address for Monthly Statement:
Nearest Supagas Branch:  Ingleburn (NSW)    Wollongong (NSW)    Newcastle (NSW)    Beenleigh (QLD)
Gas Interested in: *  Industrial     Hospitality     LP Gas     Heaters & HeatagasTM
Please specify which gases:*
How did you hear about Supagas?:*  Flyer    Internet    Trucks    Referral    Sales Rep    Tradeshow    Shop-a-docket    Newspaper
 Radio    Yellow / White pages    Yellow / White pages online    Billboard    Other  

Please specify:
  Please email gas compliance certificate and proof of identification to us at sales@supagas.net.au
 
I understand and agree to the terms & conditions