First Name* Last Name*

Email* Phone*

Trading Name* Company Name*

ABN* Contract End Date

Existing electricity supply agreement

Please email your electricity invoice to admin@energywise.net.au

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assessment, and can be withdrawn by the retailer at any time prior to the expiry period.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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