Priority Services Registration

Priority Services Program Application Form

By applying for the Australian Gas Networks’ (AGN) Priority Services Program, we aim to provide you with access to additional support and services when you need them. This support can be for you, or someone else in your household.

Please note that the application cannot be processed until all sections have been completed. For more information or assistance in completing this form, please call us on 1300 427 777 (Monday to Friday, 8am-5pm) or email customercare@agig.com.au

You can also print the Priority Services application form and send to us via email customercare@agig.com.au or post PO Box 449 Mt Waverley VIC 3149.

Download Priority Services Program Application Form (PDF)

Step 1

Step 2

Step 3

Step 4

Step 5

Step-1: Applicant details

First Name* This field is required

Last Name* This field is required

Phone Number (Either mobile or phone is mandatory) A valid Australian phone number (0XXXXXXXXX) is required

Mobile Number (Either mobile or phone is mandatory) A valid Australian phone number (0XXXXXXXXX) is required

Email Address* A valid email is required

Meter Identification Reference Number (MIRN) * This field is required

You will find your MIRN on your gas retail bill (often on page 2). It should also be on your gas meter.

Residential Address*
House Number*
This field is required Street address*
This field is required Suburb/town*
This field is required Postcode*
This field is required State*

This field is required

Postal Address (if different from residential address)

House Number*
Street address*
Suburb/town*
Postcode*
State*

Preferred Method of Communication (please select all that apply)

Telephone SMS Email Hardcopy / Letter (in the post) Other, please specify

0/100 characters

Preferred Language Other Than English (please specify)

Mandarin Italian Greek Vietnamese Other, please specify

0/100 characters

Step-2: Eligibility

The Priority Services Program has been designed to support customers who are experiencing vulnerability and need us the most. To assist us in determining if you, or someone in your household, is eligible to be included in the program we need to understand the nature of your current vulnerable circumstances.

Find out more about eligible circumstances here .

AGN will only use your personal information for the purposes for which it is collected. See our Privacy Policy for more information about the privacy protections that AGN gives your personal information.

Current Circumstances*

0/500 characters

This field is required

Step-3: Authorised Representative

As an AGN Priority Customer you can nominate an authorised representative to be added to your Priority Services account. This could be a family member, friend, or trusted neighbour, over 18 years of age.

A fully authorised representative has the authority to act on your behalf. An authorised representative is permitted to make changes to your account or request new services on your behalf.

Representative First Name

Representative Last Name

Representative Email Address A valid email is required

Representative Phone Number A valid Australian phone number (0XXXXXXXXX) is required

Representative Mobile Number A valid Australian phone number (0XXXXXXXXX) is required

Representative Postal Address

House Number

Suburb/town

Street address

Postcode

State

If you would like to discuss other authority options, please contact us via phone (1300 427 777) or email (customercare@agig.com.au).

Step-4: Privacy Agreement

By completing and submitting this Priority Services Application form you are providing AGN with your consent to use your personal information to include you in the Priority Services Program and to process your personal information for the purposes of operating the program. By providing us with your personal information (which may include sensitive information), you consent to us collecting such information and to its disclosure within the Australian Gas Infrastructure Group* , but only for the purposes for which it was collected.

If you are accepted into the Priority Services Program, you agree that we may share your personal information (which may include sensitive information) with our contracted service providers or relevant third parties (e.g., gas fitters or plumbers) solely for the purpose of delivery services relating to the program.

The full details of AGN’s (part of the Australian Gas Infrastructure Group) Privacy Policy can be found here.

* The Australian Gas Infrastructure Group (AGIG) is comprised of Australian Gas Networks Limited ACN 078 551 685 (“AGN”), Multinet Gas Distribution Partnership ABN 53 634 214 009 acting on behalf of Multinet Gas (DB No 1) Pty Ltd ABN 66 086 026 986 and Multinet Gas (DB No 2) Pty Ltd ABN 57 086 230 122 (“Multinet”), DBNGP (WA) Nominees Pty Limited (ABN 78 081 609 289), as trustee of the DBNGP WA Pipeline Trust and AGI Development Group Pty Limited (DBP) and their related bodies corporate. This field is required

Step-5: Confirmation

I wish to apply for the Priority Services Program. This field is required I confirm that the person referred to in Step 1, as experiencing vulnerable circumstances, lives in my home. This field is required I acknowledge that AGN has the right to reject my application if the eligibility criteria (outlined here ) have not been met or my application is incomplete or inaccurate. This field is required I confirm that all information provided in this application form is correct. I acknowledge that if AGN approves my application and it is subsequently discovered that I was not eligible for Priority Services, AGN reserves the right to charge me for any additional costs incurred as a result, such as providing me a gas appliance safety check, repair or appliance rebate. This field is required

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