ServicesPower CutsHelp
SERVER12
Help and Advice

Priority Services Register

Application form

To receive extra support during a power cut, if you live in our area (type in your postcode to check that you are) please complete the short form below or download the application form.

We take our data privacy seriously, if you would like to view our Data Policy please click here. You can also view the Priority Services Promise here.


Address: House number or name *

Postcode:*

Who should we contact about the property during a power cut?
Title:

First name:*

Last name:*

Telephone number:*

Mobile number:

Email address:


Is there anyone else we can contact about the property during a power cut?
Title:

First name:

Last name:

Telephone number:

Mobile number:

Email address:

Please select if anyone in the properties needs meet any of the following criteria:
Reasons for inclusion:*
  Rely on medical equipment
  Chronic/ serious illness
  Safety concern
  Poor mobility
  Communication need
     (such as blind, partially sighted, Deaf or non-English speaking)

  Dementia
  Developmental condition
     (such as ADHD, Autism Spectrum Disorders, Down Syndrome and Dyspraxia)
  Pensionable age
  Family with young children 5 or under
  Mental health
  Temporary registration
     (such as a recent bereavement, divorce, redundancy, major surgery or stay in hospital)


To offer this service, we'll keep your information you have given us and only contact you if there is a power cut or to provide information about the Priority Services Register.

To help us ensure that this service is as effective as possible every year we employ a third party to check that the telephone numbers that we have on our Priority Service Register are still in use. They use publicly available sources and should not telephone you directly. You can update your information at any time. If you are completing this form on behalf of someone else, by completing it you confirm that you have the permission of that person to do so.We will not sell or pass on your information to any other third party for any purpose. For more information on how we will treat your personal data, please read our privacy policy.


Would you like to receive priority support from your energy supplier (the company you pay your energy bills to) including their meter operators and your gas distribution company? If so, tick here and we can pass your information on .



* Mandatory field