Priority Services Register Application

Customer Details

Title:

First name:

Last name:

Date of Birth:

Email:

Phone Number:

Customer Reference Number:

How to find your Customer Reference Number

You can find your unique, 10-digit 'Customer Reference Number' on any letter you have received from us.
It will always be located on the first page of our letters, in the top right-hand corner: Customer Reference Number: XXXXXXXXXX

Address Details

House Name/Number:

Address 1:

Address 2:

City:

County:

Postcode:

I would like to add a nominated person to my account

Nominated Person's Details

Title:

First name:

Last name:

Email:

Phone Number:

Relationship:

I would like to give this person 'information only' permission.

Your nominated person will be able to access all information on your account such as vend codes and usage. However they will not be able to change any details on you account.

I would like to give this person 'full consent' permission.

Your nominated person will be able to change your personal information, address and other details. You can withdraw this consent at any time, in writing or over the phone.

Customer Information

Please select the relevant details below. We will store your information and update our Priority Services Register with the details you provide.

D.O.B. of youngest child:

Priority Services Register

"In the event of a gas/electricity related emergency, Utilita Energy would like to share your PSR information with network and meter operators, this will notify them of any special requirements and allow them to prioritise the service for your property. If you do not consent to this, we will be unable to share your PSR information and your property will not be prioritised. We will never use this data for sales or marketing purposes."

Do you agree to share your priority services data with network and meter operators?

Yes No

"Utilita Energy may share your priority services information with internal and third parties who are involved with offering extra support to our priority services customers. We will only share this information to ensure customers on our PSR are receiving the full support available."

Do you agree to the above statement?