Victorian Energy Upgrades (VEU) Program

Customer Consent Form

Residential premises. To receive a phone call, email or SMS with more information about the services we offer under the VEU program, please complete and sign the declaration below.

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Customer Information

First Name *

Last Name *

Home Phone

Mobile Phone *

Email Address *

Property Address *

Preferred contact method *

Phone Email SMS

I am over 18 years of age *

Yes No

I need support to understand and agree to contracts *

Yes No

Customer Consent Declaration

I consent to Ackwire Energy contacting me to provide information about the below prescribed activities under the Victorian Energy Upgrades (VEU) program. I understand that my consent lasts for but I can withdraw my consent at any time.

Prescribed activities *

Water Heating Space Heating / Cooling

Product *

Solar Battery EV Charger Heat Pump AC

Select all the products you would like information about.

Signature

Signature *

Sign here with your finger or mouse

By signing, you confirm you have read and agree to the consent declaration above.

Date *

Please complete the highlighted fields before submitting.

Your details are used only to contact you about VEU program services and are handled in line with the Ackwire Energy privacy policy.

Consent Received

Thank you — your consent form has been submitted. A member of the Ackwire Energy team will be in touch using your preferred contact method.

Ackwire Energy · 1300 289 803 · [email protected] · 5/8 Garden Rd, Clayton VIC 3168