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Priority Services Registration

Please complete all fields marked *

Title
First name help text
Last name
Please enter a postcode
Please enter a house name or number
Please enter an address line 1
Please enter an address line 2
Please enter a town
Please enter a county
Please enter a postcode
Home phone is required
Mobile phone
Text phone
Email
If you would like to nominate a person as your contact for priority services, please tick below.
Nominate contact
Nominate contact
Home security visit: if you would like us to use a password when we visit you, please enter it below (no more than 10 characters).
 If you would like us to use a password when we visit you, please enter it below (no more than 10 characters).
Please tell us your reason for registering:
Medical Equipment
Medical Equipment type
Please tell us any other reasons: (tick all boxes that apply)
Chronic Illness
Disabled
Blind or partially sighted
Deaf or hard of hearing
Short term illness
Children under 5
Over 60
Other
Other information
Select the how did you hear about us choice
Other information for hear about us choice

What submitting this form means to you

By submitting this form you are confirming that you understand we may need to pass details to a third party before you can receive the request priority services.

We will not use or pass your details to a third party for marketing purposes.

If you have a nominated contact, you are giving your explicit consent for us to talk to your nominated contact on your behalf when providing priority services. This may mean we will share information about you and your electricity supply with them.