Vinnies LOA | MyAuto Advantage

Letter of Authority to Act

Account Holder's Name *

National Meter Identification (NMI) *

(Refer to your electricity bill for this number)

Contact Email Address: *

Contact Phone Number(s): *

In order to search for the cheapest price for electricity, we need your authority to act. Please fill in the required information, sign below and return to VINNIES, 43 Prospect Street Box Hill Vic 3128, which authorises us to source electricity offers for you but NOT accept them whithout your approval.

This authority remains valid from the date of signing unless otherwise revoked in writing by you.

Name *

First

Last

Residential Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Years at Residential Address *

Date of Birth *

Country of Birth

ID: License / Passport *

Expiry Date *

Signed: *

Signed Date: *

St. Vincent De Paul: Locked Bag 4800, Box Hill Vic 3128

Phone: (03) 9895 5800

Fax: (03) 9895 5800

Email: electricity@svdp-vic.org.au