Property Address

Flat no (if applicable) House number and street       

Town        County Postcode       

Gas

Meter Serial number Type of meter Credit Meter Prepay Meter No Gas Supply Meter Reading MPRN (if known)

Electricity

Meter Serial number Type of Meter Credit Meter Prepay Meter Meter Reading Supply type Standard (Single Rate) Economy 7 (Multiple Rate)

Supply Number (if known) S (top row) (please select) 01 02 03 04 (bottom row) (please select) 10 11 12 13 14 15 16 17 18 19 20 21 22 23

Telephone

BT socket present Yes No Not checked Dial tone Yes No Not tested Number connect a 'phone and dial 17070 to identify number

Cable TV (Virgin Media/NTL) connection present Yes No Not checked Sky TV socket and dish present Yes No Not checked

Registered by -

Name        Company Date

Property Owner

Name       Billing Address      

Date of Birth Contact number E-mail