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Name of gasfitter or contractor organising installation(Required)

Other details(Required)

Business Name(Required)

Applicant Details

Name(Required)

First Middle Last

Date of Birth(Required)

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Mobile Number(Required)

Home Phone Number

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Drivers Licence Number

Name (Second applicant)(Required)

First Middle Last

Date of Birth (Second applicant)(Required)

DD slash MM slash YYYY

Mobile Phone (Second applicant)(Required)

Home Phone (Second applicant)

Email (Second applicant)(Required)

Drivers Licence Number (second applicant)

Address

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Is your postal address different to the address above?(Required)

No

Yes

Postal address

Preferred first delivery date

I will advise date when first delivery is required(Required)

I'm waiting until my current cylinders are almost empty and I will contact Rockgas Cambridge closer to the time to place my first order.

I would like to book my first delivery in for a specific date.

New LPG installations or new builds - I will contact Rockgas Cambridge closer to the time when I have a confirmed date cylinders need to be on site.

New LPG installations or new builds - I would like to book my first delivery in for a specific date.

I have purchased/am moving into a new property - please advise your settlement/takeover date.

Date(Required)

DD slash MM slash YYYY

Cylinder Information

What will the LPG be primarily used for?(Required)

Hot water

Cooking

Heating

Forklift

Other

Cylinder Size(Required)

Most standard installations are set up for 45KG cylinders. Why have you requested 19KG cylinders?(Required)

How many cylinders is your LPG installation set up for?(Required)

Most standard LPG installations are set up to take 2 x LPG cylinders. What is the reason for only requesting one?(Required)

Are there already cylinders at this property?(Required)

Who are these cylinders supplied by?(Required)

Other Supplier(Required)

Switching

If you are switching suppliers: On our first delivery we will deliver two Rockgas cylinders and will remove the cylinders currently on site from your previous supplier. We organise for them to be returned to the previous supplier depot at no cost to you.

Property Details

Hazards

No hazards

Dog

Steps

Locked gate

Steep driveway

Slippery path

Difficult street parking

Other

Hazards other(Required)

Special delivery instructions for first delivery?

Special delivery instructions for ongoing deliveries?

Do you own the property?(Required)

Yes (Rental is an up-front annual charge of $65 per cylinder)

No

If 'no' fill out the landlord details below.

Landlord Name

Landlord Phone Number

Landlord Email

Landlord Address

Have you discussed with your landlord about them paying for the cylinder rental charges?(Required)

For more information on gas bottles in relation to tenancy agreements please visit the following link: https://www.tenancy.govt.nz/rent-bond-and-bills/utilities-and-other-payments/

Yes - My landlord will be paying these charges

No - I will be paying these charges. (Rental is an up-front annual charge of $65 per cylinder))

Other Information

Paperless statements

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Contact

P: 0800 494 559
E: orders@rockgascambridge.co.nz

Rockgas Cambridge
107D Hautapu Road, Cambridge

Opening Hours
Mon – Fri 9am – 5pm

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If you have a complaint please contact us on 0800 494 559 or email office@rockgascambridge.co.nz
If we cannot resolve your complaint you can contact the Electricity & Gas Complaints Commssion’s free & independent service on 0800 22 33 40 or email info@complaints.co.nz

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