Participants Details
Title
MISS
MR
MRS
MS
First Name *
Last Name *
Email Address *
Work Phone Number
Mobile Phone Number
Home Phone Number
Best Number For Contact *
-- Please select --
Mobile
Home
Work
Home Address *
City *
State *
Zipcode/Postcode *
Country *
-- Select Country --
AUSTRALIA
Work Address
City
State
Zipcode/Postcode
Country
-- Select Country --
AUSTRALIA
Ergon Electricity Account Details
Is the Installation address connected to the electricity network
-- Please select --
Yes
No
Name shown on account
Installation Address Street
Installation Address Suburb
Address shown on account (not postal address)
Account Number
NMI Number
What is your daily average energy consumption refer to your most recent power bill
I agree to have Climatecare Electrical prepare my Application for an IES agreement
-- Please select --
Yes
No
Home Assessment
Roof Orientation --Array Site facing -- Note South Not Suitable
-- Please select --
North facing
East facing
West facing
Roof Pitch Estimate
-- Please select --
10 degrees
15 degrees
20 degrees
Building Height
-- Please select --
Single Storey
Double Storey
Split Level
Roof Material
-- Please select --
Iron
Tile
Other
Year of Home Construction
Type of Home Construction
-- Please select --
Brick
Timber
Hardiplank
Texture
Is there access to ceiling space
-- Please select --
Yes
No
I would like a site visit
-- Please select --
Yes
No
Solar System Details
Number of Panels
-- Please select --
6
7
8
9
10
11
12
14
16
18
20
22
Inverter size KW/Model
-- Please select --
2.2
2.8
3.3
4.4
5
Inverter Extended Warranty
-- Please select --
Yes
No
Meter Box suitable for Ergon IES Metering
-- Please select --
Yes
No
Unsure
Meter Box suitable for Ergon IES Metering
-- Please select --
Yes
No
Unsure
Tilt Frames required
-- Please select --
Yes
No
Unsure
Renewable Energy Certificates
I am eligible for Solar Credits incentive and have nor previously received an SHCP/PVRP rebate, nor preapproval for an SHCP rebate, nor Solar Credits at the installation address.
-- Please select --
Yes
No
Are you the owner of the installation address
-- Please select --
Yes
No
I would like to Pre Assign the REC”s as a point of sale discount
-- Please select --
Yes
No
Terms and Conditions
I have read and understood the terms and conditions and accept them in Full *
-- Please select --
Yes
No
Date * A pop up calendar will appear... just click the highlighted date.
SUBMIT BUTTON ( By submitting I am not agreeing to order a system, only by payment of a deposit will I be contracted to Climatecare Electrical BUYING LOCAL group offer) *
-- Please select --
Yes I understand this is not an agreement to order a system
