Fields marked with an [ * ] are required Aplication Form Expression of Interest Form Select Your Area* South Australia Victoria Does this site have an existing Inverter * Yes No If Yes , please specify capacity of the existing system: Surname: * Given name: * Name must match exactly to the name on your electricty bill Electricity Retailer: * National Metering Identifier (NMI): * Contact Name : * Postal Address for Correspondence: * (If different than shown above) Postcode: * Telephone: * Mobile: Email: * Is the site a bulk metered site? * Yes No Street No.:* Street Name: * Suburb: * Postcode: * Additional Location Information: Is your home more than 2 stories? * Yes No Is your home heavily shaded by trees, buildings, ETC...? * Yes No How did you hear about us? Google Yahoo Advertisment Would you be interested in purchasing a Jasmin solar system (up to 5kW capacity) for just $1, when we expand our operations to South Australia? * Yes No I have read and agree to the Terms and Conditions * I have read and understand The Offer * JASMIN Solar requires that you certiify your application by submitting an electronic signature. To certify your application you must agree to the above "Terms and Conditions", provide an electronic signature (type your name) below, and then click "Submit Application". I certify all the information in my application is accurate and true. ACN: 158 644 225 ABN: 62158644225 Enter Electronic Signature: * (Type your name)
