Name *

First Name

Last Name

Phone

(###)

###

####

Preferred Method of Contact *

Choose from the options below

Phone

Email

Post

Any

Are you over the age of 18? *

Yes

No

Have you experienced anything recently that could make it harder for you to manage your energy account?

These are temporary and will be removed from your account after 3 months

Life changes (e.g. bereavement, job loss)

Post hospital recovery

Do you need extra time answering the door? *

Yes

No

Would you like a smart meter installed so that you don't need to read your meter? *

Yes

No

Do you need help reading your meters? *

Yes

No

Would you like us to go over your bills with you?

Yes

No

Can you access your meters as it stands?

Or would you need them relocated to read them?

Yes I can access my meters

I need my meters relocated

Do you need an additional presence if we need to send an agent to your house? *

For example to repair your meter if it develops a fault

Yes

No

Would you like to nominate someone else to help manage your account moving forward? *

Yes

No

Please consent to the below *

In order to enrol you onto the industry Priority Services register we will need your consent to share your details with some external partners. We will only ever share your details with people who absolutely need to know, and the information will only be used in the event of an emergency. For example we may need to share this with the District Network Operator (the people in charge of all the wires and pylons) - if there is a planned power cut in your area they will give you advanced notice, and in some cases they will even come and provide a generator for you.

I give my consent