sign-up-form

Sign Up Form

  • Mr.
  • Mrs.
  • Ms.
  • Miss
  • Prof.
  • Dr.

For credit check purposes, please provide us with your NZ driver license number  and card version number, or other proved identification number below, if possible.

  • Day
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25
  • 26
  • 27
  • 28
  • 29
  • 30
  • 31
  • Month
  • January
  • February
  • March
  • April
  • May
  • June
  • July
  • August
  • September
  • October
  • November
  • December
  • Year
  • 2019
  • 2020
  • 2021
  • 2022
  • 2023
  • 2024
  • 2025
  • 2026
  • 2027
  • 2028
  • 2029
  • 2030
  • 2031
  • 2032
  • 2033
  • 2034
  • 2035
  • 2036
  • 2037
  • 2038
  • 2039
  • 2040
  • 2041
  • 2042
  • 2043
  • 2044
  • 2045
  • 2046
  • 2047
  • 2048
  • 2049
  • 2050
  • 2051
  • 2052
  • 2053
  • 2054
  • 2055
  • 2056
  • 2057
  • 2058
  • 2059
  • 2060
  • 2061
  • 2062
  • 2063
  • 2064
  • 2065
  • 2066
  • 2067
  • 2068
  • 2069
  • 2070
  • 2071
  • 2072
  • 2073
  • 2074
  • 2075
  • 2076
  • 2077
  • 2078
  • 2079
  • 2080
  • 2081
  • 2082
  • 2083
  • 2084
  • 2085
  • 2086
  • 2087
  • 2088
  • 2089
  • 2090
  • 2091
  • 2092
  • 2093
  • 2094
  • 2095
  • 2096
  • 2097
  • 2098
  • 2099
  • 2100
  • 2101
  • 2102
  • 2103
  • 2104
  • 2105
  • 2106
  • 2107
  • 2108
  • 2109
  • 2110
  • 2111
  • 2112
  • 2113
  • 2114
  • 2115
  • 2116
  • 2117
  • 2118
  • 2119
  • Day
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25
  • 26
  • 27
  • 28
  • 29
  • 30
  • 31
  • Month
  • January
  • February
  • March
  • April
  • May
  • June
  • July
  • August
  • September
  • October
  • November
  • December
  • Year
  • 1919
  • 1920
  • 1921
  • 1922
  • 1923
  • 1924
  • 1925
  • 1926
  • 1927
  • 1928
  • 1929
  • 1930
  • 1931
  • 1932
  • 1933
  • 1934
  • 1935
  • 1936
  • 1937
  • 1938
  • 1939
  • 1940
  • 1941
  • 1942
  • 1943
  • 1944
  • 1945
  • 1946
  • 1947
  • 1948
  • 1949
  • 1950
  • 1951
  • 1952
  • 1953
  • 1954
  • 1955
  • 1956
  • 1957
  • 1958
  • 1959
  • 1960
  • 1961
  • 1962
  • 1963
  • 1964
  • 1965
  • 1966
  • 1967
  • 1968
  • 1969
  • 1970
  • 1971
  • 1972
  • 1973
  • 1974
  • 1975
  • 1976
  • 1977
  • 1978
  • 1979
  • 1980
  • 1981
  • 1982
  • 1983
  • 1984
  • 1985
  • 1986
  • 1987
  • 1988
  • 1989
  • 1990
  • 1991
  • 1992
  • 1993
  • 1994
  • 1995
  • 1996
  • 1997
  • 1998
  • 1999
  • 2000
  • 2001
  • 2002
  • 2003
*Please notice 1% discount do not apply on LPG products
*Email extra 1% off do not apply on this plan
  • Day
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25
  • 26
  • 27
  • 28
  • 29
  • 30
  • 31
  • Month
  • January
  • February
  • March
  • April
  • May
  • June
  • July
  • August
  • September
  • October
  • November
  • December
  • Year
  • 2019
  • 2020
  • 2021
IF YES We can discuss options to help customers in vulnerable circumstances. HANERGY TAKES ITS OBLIGATION TO ASSIST CUSTOMERS IN VULNERABLE CIRCUMSTANCES SERIOUSLY. You can be considered vulnerable if you either: · rely on electricity due to age, health or disability and a power cut may threaten your health or well-being. · have genuine difficulty paying bills due to financial hardship. If you think you or your family fits this description or you are finding it difficult to pay your energy bills, please contact us immediately on 0800 80 9000. We’ll discuss options such as setting up a payment arrangement, applying to Work and Income or another social agency for budgeting or other advice or assistance. Also, if you believe that at some time in the future you may have difficulties with your payments or with communicating with us, you can appoint one or more alternate contacts who agree to assist if a disconnection or payment issue is pending. An alternate contact could be a family member or friend, or a social agency support person.
IF YES, If you, or someone in your household, depends on mains electricity for critical medical support, and the loss of electricity could result in loss of life or serious harm, then let us know when you sign up. Medical dependence on electricity relates to both medical equipment and other electrical equipment needed to support a treatment regime such as a microwave to heat fluids for renal dialysis. YOUR EMERGENCY BACK-UP PLAN DURING AN ELECTRICITY OUTAGE If you're medically dependent, it's important that you have an emergency back-up plan during a power cut. Power cuts can occur suddenly during bad weather or unplanned emergency repairs. Your back-up plan could include: · Having a back-up battery that is always charged up. · Relocating to a friend or family members house. · If it's really serious, then calling the ambulance to be taken to the hospital.
IF YES, Please tell us if the disconnection of main electricity presents a clear risk to your (or that of someone in your household) health or well-being for the reasons of age, health, disability or severe financial insecurity.
Full name of your friend