Service Disconnection Form

Complete this online application to disconnect and existing service connection at Go Bleu - Myers Street.

Go Bleu - Myers Street
23 Myers Street
Geelong 3220

Your Details

Tenant or Business Name

Phone (primary contact number)

Email Address

Supply Details

Services Choose your serviceElectricityHot Water

Unit Number Choose your unitBrandable BillingCP3G01G02Public Lighting Power APublic Lighting Power BTEST2Unit 101Unit 102Unit 103Unit 201Unit 202Unit 203Unit 204Unit 205Unit 206Unit 207Unit 208Unit 209Unit 210Unit 211Unit 212Unit 213Unit 214Unit 215Unit 216Unit 217Unit 218Unit 301Unit 302Unit 303Unit 304Unit 305Unit 306Unit 307Unit 308Unit 309Unit 310Unit 311Unit 312Unit 313Unit 314Unit 315Unit 316Unit 317Unit 318Unit 401Unit 402Unit 403Unit 404Unit 405Unit 406Unit 407Unit 408Unit 409Unit 410Unit 411Unit 412Unit 413Unit 414Unit 415Unit 416Unit 417Unit 418Unit 501Unit 502Unit 503Unit 504Unit 505Unit 506Unit 507Unit 508Unit 509Unit 510Unit 511Unit 512Unit 601Unit 602Unit 603Unit 604Unit 605Unit 606Unit 607Unit 608Unit 609Unit 610Unit 611Unit 612Unit 701Unit 702Unit 703Unit 704Unit 705Unit 706Unit 707Unit 708Unit 709Unit 710Unit 711Unit 712Unit 801Unit 802Unit 803Unit 804Unit 805Unit 806Unit 807Unit 808Unit 809Unit 810Unit 811Unit 812Unit 901Unit 902Unit 903Unit 904Unit 905Unit 906Unit 907Unit 908Unit 909Unit 910Unit 1001Unit 1002

Supply Disconnection Date

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Notes

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