Use this form if you are a residential customer and you are applying for:
Required fields are marked with an asterisk (*)
Connection and disconnection requests may take three business days to be processed. If your request is urgent, call us directly on 1800 JACANA (1800 522 262). Connection and disconnection fees apply. For information visit the Pricing and Tariffs page.
Account number (if existing customer)
First name *
Middle name *
Last name *
Date of birth *
Nominate a 4-digit PIN to protect your account or enter your 4-digit PIN if you already have one.
Preferred delivery method (bills and correspondence)
Form of identification (e.g. DL, passport) *
Identification number *
State of issue
Expiry date *
NT Concession Scheme card number (issued by Territory Families)
Level of authority
For more information about authorities, visit the Additional authority page.
Date of birth
Form of identification (e.g. DL, passport)
Please fill in at least one of the following fields: Lot no, Unit no or Street no
Street name *
If there are access restrictions to your property such as locked gates or dogs, the disconnection will not take place and you will be liable for usage and supply charges until access is granted.
Requested disconnection date *
Street address / PO Box *
Requested connection date *
If there are access restrictions to your property such as locked gates or dogs, the connection will not take place.
Does the property have solar panels?*
By submitting this application, you: