Survey : Questions

	Community Bulk Buy Energy Scheme Organised By: Local Residents - Stanley and Upper Brisbane Catchment Community

	We respect your privacy. Your personal information will not be sold to any third parties. It will be used by Power Group Purchasing when necessary to communicate updates to you.

1.

Please indicate whether you are registering a home or your local business.

Home

Local business consuming Less than 100,000 KWh per annum

Local business consuming More than 100,000 kWh per annum

Comment:
500 characters left.

2.	Business Name (If applicable)
	50 characters left.

3.	First Name
	50 characters left.

4.	Last Name
	50 characters left.

5.	Street No. / Street Name
	50 characters left.

6.	Suburb
	50 characters left.

7.	State
	50 characters left.

8.	Post Code
	50 characters left.

9.	Email: (PowerGroup Purchasing will keep in contact with residents via email)
	50 characters left.

10.	Please re-enter your email address
	50 characters left.

Please note: The selected energy retailer may wish to set up a promotional code for the energy deal and a dedicated telephone number for people to contact them on. Details will be provided when the selected retailer is announced.

Details of the winning energy retailer will be emailed or posted to you if you provide your postal address details. Information will also be announced in the community projects section at www.powergrouppurchasing.com

Please enter your telephone contact number below if you authorise to be contacted by PowerGroup Purchasing or the winning energy retailer about the selected offer, even if you are registered on the do not call register.

11.	Yes I authorise the selected energy retailer to call my number below and discuss the selected energy deal.
	50 characters left.

12.	Name of your current energy retailer (free text)
	50 characters left.

13.

How many electricity meters do you have?

One

Two or more

Comment:
500 characters left.