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Name of account holder*
Business Trading Name*
Email address*
Contact telephone number*
Alternative contact number
Property Details
Street Address*
Address Line 2
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Is your postal address the same as your Delivery Address?*
- Yes, the same as above
- No, different
Postal Street Address*
Postal Address Line 2
Postal Town / City*
Postal Post Code
Ownership of Property*
Bottle Details
Number of 45kg cylinders required*
Delivery Information*
- Dogs on site
- Locked gates
- Down a row
- Number on letterbox
- Is property easy to locate
- Other
Description of property for delivery purposes
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P: 03 3195 492 (ext 1)

Rockgas Kaikoura
55 Beach Road
Kaikoura
Canterbury 7300

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If you have a complaint please contact us on 03 3195 492 (ext 1). If we cannot resolve your complaint you can contact the Electricity & Gas Complaints Commssion’s free & independent service on 0800 22 33 40 or email info@complaints.co.nz

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