Register for Priority Services

Your Details

Customer Account Number*

Title*

Forename*

Surname*

Address*

Street Address Address Line 2 Town/City County Post Code

Date of birth*

Contact phone number*

Please provide your preferred telephone number so we can get in contact with you in case of a water incident

Email address*

You don’t need an email address to register for Priority Services

Where did you hear about our Priority Services?

If your circumstances have changed, and you no longer wish to be on the Priority Services Register, please tick the box below. You can contact us at any time to remove your details.

Please take me off the register

Your needs

To make sure that we register you for the correct services, please tick all of the boxes that apply to you.

Reason

Temporary Reason

Post hospital recovery
Life changes
Young adult householder

Any other specific needs which may mean you need some extra help?

Other Services

Please let us know if you require these services

Bills in large print
Please telephone me to read my bill
Bills in braille

Register a Password

This password will be used every time we visit your home.

Nominate a Helper

I would like to nominate someone as my Priority Services contact.

Name of Nominee

Their Address

Street Address Address Line 2 Town/City County Post Code

Their phone number

Relationship to you

Submitting this form you agree to the following notice:

The information you have provided about yourself, or about someone else on their behalf, will be used to make sure the right service and/or support is provided. We will record the information selected on the relevant account and keep it for as long as you want us to. We will contact you from time to time to ensure we are providing the right level of support and to see if you require any additional assistance. This data will be shared with third parties to ensure they can arrange similar services and/or support.

We do retain personal data that you provide to us. For more information on how we process your data and for details on how to opt out of non-essential messages, please see our Privacy Notice

Thank you for your time in completing this form, it will help us provide the best service possible for you.

Please allow 10 working days for us to process your application.

Comments

This field is for validation purposes and should be left unchanged.