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Account Type
Would you like this account to be billed to:*
What type of connection is this?*
Is this for residential or business usage?*
How did you hear about us?*
Name of gasfitter or contractor organising installation*
Other details*
Business Name*
Applicant Details
Name*
First Middle Last
Date of Birth*
DD slash MM slash YYYY
Mobile Number*
Home Phone Number
Email*
Photo ID (Drivers License, Passport, etc)*
Attach Photo ID*
Accepted file types: jpg, gif, png, pdf, Max. file size: 300 MB.
Max file size 2MB.
Name (Second applicant)*
First Middle Last
Date of Birth (Second applicant)*
DD slash MM slash YYYY
Mobile Phone (Second applicant)*
Home Phone (Second applicant)
Email (Second applicant)*
Photo ID (Second applicant)*
Attach Photo ID (Second applicant)*
Accepted file types: jpg, gif, png, pdf, Max. file size: 300 MB.
Max file size 2MB.
Address
Address of property requiring LPG*
City*
Is your postal address different to the address above?*
- No
- Yes
Postal address
Preferred first delivery date
I will advise date when first delivery is required*
- I'm waiting until my current cylinders are almost empty and I will contact Rockgas Wanganui closer to the time to place my first order.
- I would like to book my first delivery in for a specific date.
- New LPG installations or new builds - I will contact Rockgas Wanganui closer to the time when I have a confirmed date cylinders need to be on site.
- New LPG installations or new builds - I would like to book my first delivery in for a specific date.
- I have purchased/am moving into a new property please select your settlement/takeover date - please advise your settlement/takeover date.
Date*
DD slash MM slash YYYY
Cylinder Information
What will the LPG be primarily used for?*
- Hot water
- Cooking
- Heating
- Forklift
- Other
Cylinder Size*
Most standard installations are set up for 45KG cylinders. Why have you requested 19KG cylinders?*
How many cylinders is your LPG installation set up for?*
Most standard LPG installations are set up to take 2 x LPG cylinders. What is the reason for only requesting one?*
Are there already cylinders at this property?*
Who are these cylinders supplied by?*
Other Supplier*
Switching
- If you are switching suppliers: On our first delivery we will deliver two Rockgas cylinders and will remove the cylinders currently on site from your previous supplier. We organise for them to be returned to the previous supplier depot at no cost to you.
Property Details
Is there a Dog on-site?*
Are there any site access issues that we need to be aware of ?
Special delivery instructions for first delivery?
Special delivery instructions for ongoing deliveries?
Do you own the property?*
- Yes
- No
If 'no' fill out the landlord details below.
Landlord Name
Landlord Phone Number
Landlord Email
Landlord Address
Would you like a comparative quote for your electricity from Contact?*
- Yes
- No
Have you discussed with your landlord about them paying for the cylinder rental charges?*
- Yes - My landlord will be paying these charges
- No - I will be paying these charges
For more information on gas bottles in relation to tenancy agreements please visit the following link: https://www.tenancy.govt.nz/rent-bond-and-bills/utilities-and-other-payments/
How would you like to pay for the cylinder rental charges?*
- Yearly ($63.00 per cylinder per year)
- Monthly ($7.50 per cylinder per month)
Cylinder rental charges are paid in advance.
ICP Number*

Your ICP number is found in the top right hand corner of your power bill.
Credit Check*
- I authorise Rockgas Wanganui to obtain a Credit Check
Terms & Conditions*
- Yes, I have read and agree to the Rockgas Terms & Conditions
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Contact

P: 0800 574 2968
E: sales@rockgaswanganui.co.nz

Rockgas Wanganui
73 Putiki Drive
Wanganui 4500

Office Hours
Mon-Fri- 8am – 5 pm

Shop Hours
Mon-Fri 8am-5.30pm
Sat 8am-1pm
Sunday – Closed

Yard Open
Mon-Fri 8am–5pm

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If you have a complaint please contact us on 0800 574 2968 or email sales@rockgaswanganui.co.nz
If we cannot resolve your complaint you can contact the Electricity & Gas Complaints Commssion’s free & independent service on 0800 22 33 40 or email info@complaints.co.nz

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