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First Name* Last Name*
Email* Phone*
Trading Name* Company Name*
ABN* Contract End Date
Existing electricity supply agreement
Please email your electricity invoice to [email protected]
In addition to evaluating energy saving opportunities for your business, we are able to evaluate your electricity contract to
ensure you are on the best market rate and the appropriate tariff. There is no cost or obligation with this service. Please read
the following terms and tick the box if you would like to receive this service.
I understand that by accepting the terms below we are appointing Energywise Pty Ltd and their electricity procurement partner Fortiserve
Group Pty Ltd (trading as Leading Edge Energy (Agent)) as our Agent:
Agent is providing a professional service in good faith and at no cost to us.
Agent may contact energy retailers to request account data and use this information to forecast our total energy
spend in the following calendar years.
Agent may negotiate pricing offers from energy providers on our behalf, for our consideration. Under no
circumstances does this authorise the Agent to enter into contracts or accept offers on our behalf.
We understand that any offer negotiated by Agent for us is subject to a strict expiry date, a favorable credit
assessment, and can be withdrawn by the retailer at any time prior to the expiry period.
This authority is valid for 24 months from the date of signing.
Energywise and Fortiserve may contact us from time to time in the future to share special offers.
Obligation Free Electricity Evaluation
Electricity Evaluation Date:
Signature*
Post Code* Electricity retailer
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