NEW ORDER FORM

Please fill in the required information and one of our consultants will be in contact with you shortly.

* Indicates mandatory field


Please indicate your work category, by clicking on one of the following: *

BUILDER
MERCHANT
PLUMBER
Company Name
*
Customer's Billing Address
No. Street / Road
  *

Suburb / Town

*

State
Postcode
 

Customer's Contact
*
Phone No.
*
Customer's Order No.
*
Customer's Account No. with Dux

Site Contact Name
*
Site Contact Phone No.
*
Address of Install
Lot No. Street / Road
    *

Suburb / Town

*

State
Postcode
*

Target Date of Install
*

Plans to be sent to Dux Connect by

Fax

Post

E-mail (duxconnect@dux.com.au)

Solar Panels

1 Panel 2 Panel 3 Panel

Select the following options (Please tick appropriate boxes)

Frost Valve

Cyclone Brackets

Flat Roof Frame

Copper Tails left in ceiling

Sensor Wire

Sensor Wire in Ceiling
OR
 Sensor Wire left at Hot Water Unit **

** If so, plans must include location of hot water unit and must be ordered before wall covering.

Additional Notes on Install

For confirmation on your order being received - please enter your e-mail address or mobile phone no.

E-mail Address

Mobile No.