An independent trading division
of Wanganui Gas Limited

PO Box 7149,
Wanganui 4540

Ph (06) 349 0909
Fax (06) 349 0135
Online Enquiries

Appendix B.

DISTRIBUTION SERVICES REQUEST FORM

Please print this form and complete the following details.

SYSTEM USER DETAILS

Name:  
Contact Name:  
Address:  
Phone:  
Fax:  
Email:  

SITE DETAILS

RECEIPT POINT
Name:		  
DELIVERY POINT
Name of End User:		  
WGL Identification No. (if known):  
Street Address:

 

 

 

 
Date Supply Required:  

SUPPLY DETAILS

PRESSURE (select one)
Nominal, Maximum or Minimum?		  
QUANTITIES (select one)
Maximum Hourly (MHQ):
Maximum Instantaneous (MIQ):
Nominated Annual (NAQ): Nominated Monthly (NMQ):		  
METERING
Meter Location: Please attach plan showing meter and service pipe location details
Outlet Pipework Size:
Any Non Standard Requirements:		  
LOAD MANAGEMENT
ANZIC Classification
Loadshedding Category		  
OTHER
Trench to be Provided (specify length & location):
Letters of consent from landowners attached:
Yes / No / Not applicable		  
Signed                  Name                         Date  

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