Last Name (required)
Date of Birth (required)
Mobile Phone (required)
Concession Card Type
Concession Card Number
Concession Expiry Date
The Australian Government Department of Human Services (the department) to provide the results of that enquiry to Future X Power.
I understand that:
The department will use information I have provided to Future X Power to confirm my eligibility for the relevant concession and will disclose to Future X Power personal information including my name, address and concession card type and status.
This consent, once signed, remains valid while I am a Customer of Future X Power unless I revoke it by contacting Future X Power or the department.
I can obtain proof of my circumstances/details from the department and provide it to Future X Power so that my eligibility for the relevant concession can be determined.
If I withdraw my consent or do not alternatively provide proof of my circumstances/details, I may not be eligible for the concession provided by Future X Power.
Signed: __________ Date: __________
Please read the information above and check if you agree to the concession authorisation terms
Terms and conditions can be located at: Here
Once you have submitted this application a welcome email will sent to your email address outlining the details of your agreement and what will happen next. If you have opted to receive postal communication you will receive a welcome pack from Future X Power in the mail within the next two business days. You have a 10 business day cooling off period which starts from the time you accept this agreement. If you would like to cancel please contact us on 1300 599 008
The Future X Power head office is located at Suite 2G, Level2, 33 Queen Street, Brisbane, QLD 4000
Thankyou for choosing Future X Power and enjoy your new offer!
Future X Power
Do you agree and consent ?