Priority Services Registration Form

* denotes mandatory fields

Contact Details

First name(s)*

Surname*

Contact telephone number*

Address Details

Property number/name*

Street*

Address line 2

City*

Postcode*

Eligibility

Please select all relevant options if you qualify and would like to be registered for the Priority Services Register:

Date of birth of child under 5 (or due date)

Partner/Referral Code (if applicable)

Optional: Only enter below if you are a registered community partner and have the appropriate referral details.

Remember partner details

Privacy Agreement

I agree for Northern Gas Networks to share my personal data, (including sensitive personal data) with my electricity supplier so that they can include me on their Priority Services Register. I agree that they can contact me, but only for the purposes of the Priority Services register, and to otherwise process my personal data for the purposes of operating this Priority Service Register.

Further information on the Northern Gas Networks GDPR and privacy policy can be found here.

Contact Details

Address Details

Eligibility

Medically Dependant

Mental Health Care

Safety

Poor Mobillity

Age Related

Alternative Communication

Temporary Support

Partner/Referral Code (if applicable)

Privacy Agreement