Consent Form Please enable JavaScript in your browser to complete this form.Property Type *ResidentialCommercialCustomer Details Business Name *Name *FirstLastAddress *Address Line 1City--- Select state ---New South WalesVictoriaQueenslandWestern AustraliaSouth AustraliaTasmaniaAustralia Capital TerritoryNorthern TerritoryState / TerritoryPostalPhone *Email *Preferred contact method *PhoneEmailSMSRelationship Manager *Customer Consent Declaration To receive more information about the services we offer under the Victorian Energy Upgrades (VEU) program for your business/residential premises, please accept and sign the declaration below: Please Select *I consent to being contacted by the above-mentioned relationship manager and associates to provide information about upgrade opportunities, offers and all the prescribed activities under the VEU program.I understand that my consent lasts until I withdraw it by email, text or call but I can withdraw my consent at any time.I consent to collecting and using your personal information (name, contact details, energy usage, etc.) for the purpose of processing your participation in the VEU program.Signature * Clear Signature Date Submit
