Product Registration Form

Personal Details

First Name *

Last Name *

Email Address *

Contact 1 *

Contact 2

The equipment is for *

Business Use
Residential Use

Business Name

Product Details

Where is the equipment located?

Street *

City *

State / Province

Postal / Zip code

Purchase From *

Purchase Date *

Invoice Number*

Please Upload Invoice here; (Note: Please combine in one file if to register multiple products)

Choose file or drag here

Supported format: JPG, JPEG, PNG, PDF

temp-for-124112-file2-1_

Model Number *

Serial Number *

Fill more below if you have multiple products to register:

(Item #2) Model Number

(Item #2) Serial Number

(Item #3) Model Number

(Item #3) Serial Number

(Item #4) Model Number

(Item #4) Serial Number

(Item #5) Model Number

(Item #5) Serial Number

(Optional) If you have purchased gas units, please supply certificate of compliance and provide the fully licenced gas fitter details below:

Gas equipment warranty will not be valid until your commissioning certification has been submitted.

Was the gas equipment installed by a certified gas fitter/Plumber?

Please upload Gas Commissioning Certification here:

Choose file or drag here

Supported format: JPG, JPEG, PNG,PDF

temp-for-124112-file2-2_

Comment

This Form is submitted by:

Submitter Name *

Submitter Email

Thanks for getting in touch!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

Thanks for getting in touch!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

Victorian Energy Upgrades Program

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