Electricity and if applicable Water Application with PATAC Pty Ltd Please fill out this form to become a customer of PATAC Pty Ltd for the provision of Electricity and if applicable water and then select the submit button at the end. Name* First Last House Address*-- PLEASE SELECT A HOUSE --958 Dandenong Rd960 Dandenong RdDandenong rdRoom*-- PLEASE SELECT A ROOM --Room Number 31Room Number 32Room Number 11Room Number 12Room Number 25Room Number BungalowRoom Number 13Room Number 14Room Number 15aRoom Number 15bRoom Number 21Room Number 22Room Number 23Room Number 24Room Number 50Room Number 51Room Number lobby room 1Room Number lobby room 2Room Number 52Room Number 53Room Number 54Room Number 55Room Number 56Room Number 57Room Number 58Room Number 59HiddenAccount Number Email* Phone* Date that you took possession of your premises* DD slash MM slash YYYY Do you require Life Support Systems in your premise? Yes No Agreements You will need to first view the document by clicking on each link before you can tick the boxes to proceed with your application. If you wish, prior to agreeing you can save the document, copy the link for later reference or email a copy of the document/s for your record. If you have difficulty opening or viewing any of these documents please contact us - hannahc@affordableaccom.com.au or call on 0429674647. The documents will be sent to you once you have accepted the agreement.* I agree to receive written communication, notices, documents, correspondence, accept agreements and be billed electronically in relation to the provision of electricity and if applicable water at the above selected address. * I agree to the terms and conditions contained in the attached agreement as it relates to the sale of electricity to me. Electricity Agreement * I agree to the terms and conditions contained in the attached agreement as it relates to the sale of electricity to me. Electricity Agreement * I agree to the terms and conditions contained in the attached agreement as it relates to the sale of electricity to me. Electricity Agreement * I agree to the terms and conditions contained in the attached agreement as it relates to the sale of electricity to me. Electricity Agreement * I agree to the terms and conditions contained in the attached agreement as it relates to the sale of electricity to me. Electricity Agreement * I agree to the terms and conditions contained in the attached agreement as it relates to the sale of water to me. Water Agreement * I agree to the terms and conditions contained in the attached agreement as it relates to the sale of water to me. Water Agreement * I agree to the terms and conditions contained in the attached agreement as it relates to the sale of water to me. Water Agreement Select this button to complete and accept any agreements.General Comments from Applicant?