Service Disconnection Form

Complete this online application to disconnect and existing service connection at Go Bleu - Laila.

Go Bleu - Laila
7-11 Belsize Avenue
Carnegie 3163

Your Details

Tenant or Business Name

Phone (primary contact number)

Email Address

Supply Details

Services Choose your serviceElectricityHot Water

Unit Number Choose your unit1.011.021.031.041.051.061.071.081.091.101.112.012.022.032.042.052.062.072.082.092.103.013.023.033.043.05999Application OnlyG.01G.02G.03G.04G.05G.06G.07G.08G.09PLP

Supply Disconnection Date

Year Month Day

JanFebMarAprMayJunJulAugSepOctNovDec1234567891011121314151617181920212223242526272829303120212022202320242025202620272028202920302031

Notes

Please add any extra notes or comments here

Do you accept the Terms and Conditions?

Disconnect My Service Cancel