This form is for a new customer that would like to sign-up for Elgas LPG:
Your Client's Details
Title :
First Name *:
Surname *:
Email *:
Home Phone *:
Mobile *:
Client's Property For Cylinder Delivery
Prefix :
Street Number *:
Address *:
Suburb / City *:
State *:
Postcode *:
They are *:
Delivery Instructions (Special Requests, Inquiries, Delivery Instructions if any) :
Client's Postal Details
My client's postal address is :
Prefix :
Street Number :
Address :
Suburb / City *:
State :
Postcode *:
What will they be using the gas mostly for?
The information supplied here will help us determine the best services for their situation.
- Domestic Heating - Domestic Cooking
- Domestic Hot Water - Domestic Patio Heating
- Domestic Pool / Spa
Contractor / Installer Information - (Your Details)
Trade Business Name *:
Contact Name *:
Contact Phone Number *:
Elgas Account Number *:
Promotional Code Number *:
Date Cylinders Required *:
Number of Cylinders Required *:
Approximate Delivery Time *:
Product and Service Offers

We are committed to providing you with a complete LPG energy service, so we may present you with LPG products and household or business service offers in the future.

All offers (including electronic messages) will include information about unsubscribing. We will continue to provide you with these offers until you advise us otherwise. If you do not wish us to use, or enable our privacy compliant agents and contractors to use, your information for this purpose, please indicate so below.

I agree to receive marketing information / promotional offers from Elgas Limited at the email address above, whether I remain a customer of Elgas Limited or not.
I do not wish to receive marketing information / promotional offers from Elgas Limited.
Privacy Policy
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