Priority Customer Registration

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Priority Services Register

If you wish to join our Priority Services Register then please fill in the form below.

Fields marked with an asterisk (*) are mandatory.

Title * Click to add

First Name * Click to add

Surname * Click to add

Address Line 1 * Click to add

Address Line 2 Click to add

Town/City Click to add

County Click to add

Postcode * Click to add

Telephone * Click to add

Email Address * Click to add

Mobile Click to add

Nominated Contact Click to add

Contact Number Click to add

For security, if you would like a password then please write it below in no more than 10 characters.

When our engineers visit please ask them to contact the centre to find out your password.

Password Click to add

Please indicate your special needs from the tick boxes below. Please tick as many as you feel necessary, but you must tick at least one box.

Select choices

I am registered disabled
I have a disabled child
I am visual or hearing impaired
I am seriously ill
I have mobility problems
l am over 65

Do you or anyone in your household rely on medical equipment that is powered by electricity?

YesNo

If yes, please specify the type of equipment Click to add

Once we have received your form a member of our team will contact you to understand your needs in more detail.

Are you the customer impacted?

YesNo

If no

I am doing this on behalf of the above and have their permission to give out their details

I can confirm that all the information I have given you is true and correct. I give permission for you to store my personal details and to contact me or the impacted customer when required by any of the agreed means.

Agree

Name * Click to add

Are you a priority customer?

We appreciate that some customers have additional requirements and may have circumstances where a priority service is needed for a variety of reasons.

Learn more