Apply for our Priority Services Register

Please tell us a few details about you or your loved one so we know how to help.

Don't worry, we'll only use your information for the purposes of this register and will never share your personal information without asking you first.

Apply for our Priority Services Register

Your full name *

Email address *

Contact phone number *

Account number (eight numbers plus the check digit) *

House name/number: *

First line of your address *

Postcode *

I'd like to receive my bills in (tick all that apply)

Large print
Braille
Audio

I would like to nominate someone to view my bills and discuss them with you if needed (please note we will need to contact your nominee to obtain their consent) *

Instead of sending them to me
As well as sending them to me
If my bill is unpaid
No thank you

Nominee's full name (if chosen above)

Nominee's address and postcode

Nominee's contact phone number

I would like South East Water to use a password when contacting me by phone or calling at my home. My password is:

I give consent for the personal data provided within this form to be used for the purpose of this application *

For more information as to how we protect and use your personal data please see www.southeastwater.co.uk/privacy.