SIGN UP
Call for delivery on:
0800 56 57 56
Home
About
Your Home
Your Business
Order Gas
ManageMyGas
Rockgas App
Helpful Info
Delivery areas
FAQ
Cylinder Location Guide
LPG Bottle Basics
Contact
Search
Menu
Menu
Sign Up
Application Type
Please Choose your application type
*
Please Choose
Single Application
Joint Application
Business Application
What type of connection is this?
*
Please Choose
Switching supplier
Getting LPG installed
Moving house
Other
What company are you switching from?
*
Business Name
*
Applicant Details
Name
*
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
Title
First
Middle
Last
Mobile Number
*
Home Phone Number
Email
*
Date of Birth
DD slash MM slash YYYY
Name (Second applicant)
*
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
Title
First
Middle
Last
Mobile Phone (Second applicant)
*
Home Phone (Second applicant)
Email (Second applicant)
*
Date of Birth (Second applicant)
DD slash MM slash YYYY
Address
Address of property requiring LPG
*
Postal address if different from above
Quantity
Cylinder Size
*
Please Select
9kg
18kg
15kg Forklift
20kg Forklift
45kg
Cylinder Quantity
*
1
2
3
4
5
6
7
8
9
10
Cylinders at this property already?
*
Please Choose
Yes
No
Don't know
Preferred first delivery date
*
DD slash MM slash YYYY
Other Details
Is there a Dog on-site?
Are there any site access issues that we need to be aware of ?
Property Details
Do you own the property?
*
Yes
No
If 'no' fill out the landlord details below.
If a bond is required our office will contact you.
Landlord Name
Landlord Phone Number
What will the LPG be used for?
*
Hot Water
Heating
Cooking
Commercial
Forklift
Other
Special delivery instructions?
Who is your current electricity supplier?
Name of Gas Fitter/Company (if applicable)
Would you like a competitive quote from Contact Energy for your electricity?
*
Please Choose
Yes Please
No Thanks
How did you hear about us?
Comments
Credit Check
*
I authorise Rockgas to obtain a Credit Check
Terms & Conditions
*
Yes, I have read and agree to the Rockgas
Terms & Conditions
CAPTCHA
Email
This field is for validation purposes and should be left unchanged.
Scroll to top
