ELQ - TW Product Rectification Registration (For contractors to register on behalf of your customers for impacted sites)
Business Name *
Contact Name *
Phone *
Email Address *
Wholesaler purchased from
Account Number
End-Customer Company Name *
End-Customer Contact Name *
End-Customer Contact Phone *
End-Customer Email *
End-Customer Site Address *
Suburb *
State * Please select ACT NSW NT QLD SA TAS VIC WA
Postcode *
Estimated QTY of ELQs on Site * Please select < 10 10 - 20 20 - 50 50 - 100 100 - 500 > 500 Unknown
Number of Switchboards Impacted *
Products Impacted
Comments
