Account number (if known)

First name
Email address
Postcode, Town/city
Postcode, Town/city
Other: Electricity Gas Water

Meter number
Meter reading
Other: Electricity Gas Water

Meter number
Meter reading
Electricity
Estimated annual consumption (kWh)
or number of people in household
Gas
Estimated annual consumption (kWh)
or area to be heated (in m
2
)
Account number
Town/city, date
Sort code
Signature
Account number (if known)
First name
Email address
Postcode, Town/city
Deregistration/
change of address form
Mrs/Miss/Ms Mr Company
Date of birth (DD/MM/YYYY)
Surname
Telephone number (landline or mobile)
Address for nal statement (if different from delivery address)
Street name, house number
ENTEGA GmbH & Co. KG, Postfach 11 07 61, 64222 Darmstadt; telephone: +49 (0)800 4 800 888 (free of charge); fax: +49 (0)800 8 080 070 (free of charge)
5. AUTHORISATION, RIGHT TO CANCEL AND CONSUMER COMPLAINTS
Authorisation: I hereby authorise ENTEGA GmbH & Co. KG to undertake all the necessary activities and submit and accept all the necessary declarations in conjunction with changing
energy providers and/or gas suppliers.
By signing, I acknowledge that ENTEGA GmbH & Co. KG may, if necessary, request information pertaining to me from the relevant service providers (e.g. SCHUFA, Creditreform) for the
purposes of ascertaining my creditworthiness. This includes passing on the personal data I have provided above to said service providers or passing on of non-contractual behaviour
(e.g. payment arrears) to said service providers if this becomes applicable during the course of the contract.
Right to cancel: For details, please refer to the section entitled 5. Authorisation, right to cancel and consumer complaints overleaf.
Consumer complaints: For details, please refer to the section entitled 5. Authorisation, right to cancel and consumer complaints overleaf.
Yes, I am very interested in renewable energies and the topic of energy efciency, and would like to be kept up to date on these.
I give my consent to ENTEGA GmbH & Co. KG to contact me in relation to ENTEGA GmbH & Co. KG energy products and services (especially as regards gas and electricity-related new offers, special offers and pro-
motions) by using the telephone number(s) and email address(es) I have provided above. Consent can be revoked in writing at any time. Requests for revocation must be addressed to ENTEGA GmbH & Co. KG, Frankfurter Str.
100, 64293 Darmstadt.
A list of current prices can be found online at www.entega.de. Well also be happy to advise you; simply call our customer service department free of charge on +49 (0)800 4 800 888.
Name of nancial institution incl. town/city
Account holder
I hereby authorise ENTEGA GmbH & Co. KG to debit the bank account specied above for all amounts relating to this agreement until such time as the direct debit is cancelled. Any credit items will be credited to the
same account.
4. DIRECT DEBIT AUTHORISATION
Desired tariff:
Electricity Gas
ENTEGA kostrom ENTEGA Klimaneutrales Erdgas
ENTEGA Basis Strom ENTEGA Basis Gas

Town/city, Date Town/city, Date Signature of current account holder Signature of new account holder
3. REGISTRATION OF NEW ACCOUNT HOLDER (E.G. NEW TENANT/OWNER)
2. POINT OF CONSUMPTION
Delivery address
Street name, house number (important: please provide additional details, e.g. 1st oor, on the left)
New tenant Sale
Date of cancellation/change of address (DD/MM/YYYY)
Electricity Gas

Meter number Meter number

Meter reading (without decimal places) Meter reading (black numbers only)
1. DEREGISTRATION OF CURRENT ACCOUNT HOLDER
Mrs/Miss/Ms Mr Company
Date of birth (DD/MM/YYYY)
Surname
Telephone number (landline or mobile)
Postal address (if different from delivery address)
Street name/house number
Please complete all sections in full and in block capitals.
Further provisions
5. AUTHORISATION, RIGHT TO CANCEL AND CONSUMER COMPLAINTS
Right to cancel: You are entitled to revoke your contractual acceptance in writing (e.g. letter, fax, email) within a period of 14 days and without having to give reasons. Said period begins
upon receipt of this written instruction but not before the recipient has taken delivery of the goods (in the event of repeated deliveries of the same type of goods, not before the recipient
has taken delivery of the rst instalment) and not before we have met our obligations to inform in accordance with Art. 246, Sect. 2, in conjunction with Sect. 1, Paragraphs 1 and 2, of
the Introductory Act to the German Civil Code (EGBGB). Timely dispatch of the cancellation instruction is sufcient. The cancellation instruction is to be addressed to ENTEGA GmbH & Co. KG,
Frankfurter Str. 100, 64293 Darmstadt; fax: +49 (0)800 8 080 070, email: kundenservice@entega.de
Consequences of cancellation: In the case of a valid cancellation, the products supplied on both sides are to be returned and, if applicable, the benets derived from them (e.g. interest)
surrendered. If you are unable to return or surrender the products and benets (e.g. benets from use) received, or are only able to return them in part or in a deteriorated condition,
you will be obliged to compensate us accordingly. Any obligations to reimburse payments must be met within 30 days. The period begins for you at the time you send us your rescission,
and for us with its receipt.
End of the cancellation policy.
Consumer complaints: In the event of a complaint, particularly as regards the conclusion of a contract, the quality of the services rendered by our company in terms of energy provision
or measurement of the energy supplied, we can be reached by post at ENTEGA GmbH & Co. KG, Frankfurter Str. 100, 64293 Darmstadt; by telephone on +49 (0)800 4 800 910 and by email:
beschwerde@entega.de
To settle any disputes arising between you and our company with regard to energy provision or the measurement of the energy supplied, you are entitled to contact the consumer
arbitration service in accordance with Section 111b of the EnWG (German Energy Industry Act) by post at Schlichtungsstelle Energie e. V., Friedrichstrae 133, 10117 Berlin; by telephone
on +49 (0)30 2757 240-0, or by email at info@schlichtungsstelle-energie.de; website: www.schlichtungsstelle-energie.de
By submitting a complaint to the consumer arbitration service, the statute of limitations will be waivered in accordance with Section 204, Paragraph 1, Item 4 of the German Civil Code.
Furthermore, the Federal Network Agency (Bundesnetzagentur) can be contacted for questions related to electricity/gas provision by post at Bundesnetzagentur fr Elektrizitt, Gas,
Telekommunikation, Post und Eisenbahnen, Verbraucherservice, Postfach 80 01, 53105 Bonn; website: www.bundesnetzagentur.de; by email at verbraucherservice-energie@bnetza.de
or by fax on +49 (0)30 22480-323.
4. DIRECT DEBIT AUTHORISATION
No further provisions.
3. REGISTRATION OF NEW ACCOUNT HOLDER (E.G. NEW TENANT/OWNER)
No further provisions.
2. POINT OF CONSUMPTION
No further provisions.
1. DEREGISTRATION OF CURRENT ACCOUNT HOLDER
No further provisions.