(For contractors to register on behalf of your customers for impacted sites)
Business Name*
Contact Name
Phone*
Email Address*
Wholesaler purchased from
Account Number
End-Customer Company Name*
End-Customer Contact Name*
End-Customer Contact Phone*
End-Customer Email*
End-Customer Site Address*
Suburb*
State*Please selectACTNSWNTQLDSATASVICWA
Postcode*
Estimated QTY of ELQs on Site*Please select< 1010 - 2020 - 5050 - 100100 - 500> 500Unknown
Number of Switchboards Impacted
Products ImpactedELQ110C3TW (10A, 30mA 1 Pole)ELQ116C3TW (16A, 30mA 1 Pole)ELQ120C3TW (20A, 30mA 1 Pole)ELQ125C3TW (25A, 30mA 1 Pole)ELQ132C3TW (32A, 30mA 1 Pole)
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