Application for Electricity Feed-in Renewable Energy Generation scheme Customer details 4Customer or business name 4Unit number
4Floor number
4Street number
4Street name 4Block
4Section
4Suburb
4State
4Postcode
Premium rate payment  All systems must be approved and connected to the ActewAGL network.  Premium rate payment is dependent on the size of the unit installed.
Customer declaration 4 I confirm that the information I have provided in this form is true and correct. I acknowledge that my application will only be accepted upon ActewAGL Retail receiving confirmation from ActewAGL Distribution that my renewable energy generator has been approved and connected to the ActewAGL Distribution electricity network. I confirm that I have read, understood and accept the terms of the ActewAGL ACT Feed-in Tariff Retail Contract. 4Customer name 4Signature
4Date
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Please take a copy of the signed form for your records. Please send the signed application form to ActewAGL Retail, PO Box 250, Civic Square ACT 2608.
Office use only 4Received date
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4Processed date
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4Officer name 4Signature
4Date
/ CCA309_01
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ActewAGL Retail ABN 46 221 314 841 a partnership of ACTEW Retail Ltd ABN 23 074 371 207 and AGL ACT Retail Investments Pty Ltd ABN 53 093 631 586.