Service Disconnection Form

Complete this online application to disconnect and existing service connection at The Base Ringwood.

The Base Ringwood
93A Heatherdale Road
Ringwood 3134

Your Details

Tenant or Business Name

Phone (primary contact number)

Email Address

Supply Details

Services Choose your serviceElectricity

Unit Number Choose your unit***Not on this listB1B2B3B4B5B6B7B8B9B10B11B12B13B14B15B16B17B18B19B20B21B22B23B24B25B26B27B28B29B30B31B32B33B34B35B36B37B38B39B40B41B42B43B44B45B46B47B48B49B50B51B52B53B54B55B56B57B58B59B60B61B62CommonTEST

Supply Disconnection Date

Year Month Day

JanFebMarAprMayJunJulAugSepOctNovDec1234567891011121314151617181920212223242526272829303120202021202220232024202520262027202820292030

Notes

Please add any extra notes or comments here

Do you accept the Terms and Conditions?

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