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Request for Gas [Preliminary Notice]

Request for Gas Main Image

The meter box must be fitted in an approved position before submitting the Request for Gas form below.

For information regarding the processing of this form, please contact Alinta on 13 13 58.

We take your privacy seriously. Read our privacy policy here.






Please enter your details in the form below. Fields marked with * are mandatory.
A. ALINTA CUSTOMER ACCOUNT DETAILS
Account Number*
B. PROPERTY INFORMATION
Connection Details* New Connection
Additional Work
Pressure Upgrade
Meter Upgrade
Lot Number
Unit Number
House Number
Street*
Suburb *
Post Code *
State
Nearest Cross Street
Residential Installation* Yes    No
The dwelling is a* House    Unit    Villa    Townhouse    Duplex   
Is the property strata titled or does it share common ground? * Strata Titled    Share Common Ground    Other   
Number of Units/Villas/Townhouses
Requested Pressure* 1.25 KPA    2.75 KPA    Other KPA   
Is the distance from the front property boundary to the meter box more than 20 metres?*
Please note: Residential services over 20 metres will incur an additional charge 		Yes    No
Is the residential dwelling new or existing?* New    Existing
If the residential dwelling is new then what is the builders name?
Site Contact number
Date connection is required* / /
Meter Size* AL6    AL12    Other
Meter Box Location* On Boundary    On Property
What number and type of gas appliances are being connected?
Storage Hot Water System      Quantity:     MJ/Hr: 
Continuous Hot Water System      Quantity:     MJ/Hr: 
Pool/Spa Heater      Quantity:     MJ/Hr: 
Cooktop/Oven      Quantity:     MJ/Hr: 
Ducted Heating      Quantity:     MJ/Hr: 
Flued Heating      Quantity:     MJ/Hr: 
Bayonet Point - Internal [Heater]      Quantity:     MJ/Hr: 
Bayonet Point - External [BBQ]      Quantity:     MJ/Hr: 
Other:      Quantity:     MJ/Hr: 
Total      Quantity:     MJ/Hr: 
Is there a Type B appliance?* Yes    No
C. GAS FITTER INFORMATION
Gas Fitter Licence Number GF*
Gas Fitter Name*
Gas Fitter Company Name*
Gas Fitter Telephone*
Gas Fitter Email

PRIVACY STATEMENT

I agree and understand that Alinta Sales Pty is only required to forward my request for connection of the above Property Address to the relevant distributor -

  1. where a completed Request for Account (RFA) has been submitted in respect of the above Property Address by the property owner or tenant:
    1. on the day this Request for Gas (RFG) is submitted, if the RFG is received by Alinta before 3pm on a business day; or
    2. the next business day, if the RFG is received by Alinta after 3pm or on a Saturday, Sunday or public holiday in Western Australia; and
  2. where a completed RFA has not been submitted in respect of the above Property Address by the property owner or tenant:
    1. on the day a RFA is submitted, if the RFA is received by Alinta before 3pm on a business day; or
    2. on the next business day, if the RFA is received by Alinta after 3pm or on a Saturday, Sunday or public holiday in Western Australia.