Marketing Opt-in / Opt-out form

Required fields are marked with an asterisk (*)

Your details

First name *

Last name *

Date of birth *

Company name (if applicable)

Email address *

Phone number *

Account number

Service address *

Opt-in / out confirmation

I DO NOT want to be contacted by Jacana Energy about offers for products and services.

I want to be contacted by Jacana Energy about offers for products and services.

Our privacy policy has further information about receiving direct marketing from Jacana Energy and how we handle your information.

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