Apply for Our Priority Service

Name *

Your Good Energy account number *

Email address *

Are you of pensionable age?

How many residents of pensionable age live at the property?

What is the total number of residents?

How many residents under the age of 5 live at the property?

For children under 5, please enter their date of birth.

Please select all of the conditions below that apply to you and the people living in your home

Disabled Serious illness Restricted movement Blind Breathing difficulties Poor walking Hearing impared Heart condition Bedridden Arthritic Poor sense of smell Wheelchair user Speech difficulties Foreign Language (please specify) Other Visually impaired Learning difficulties Deaf Dementia

Please specify

Does anyone in the property have a specific dependency on electricity? Please select all electricity dependent equipment you have in your home

Stair lift Oxygen concentrator Kidney dialysis machine Bath hoist Ventilator Heart/lung machine Nebuliser Aponea monitor Other

Please specify

Do you require any of the following free of charge services?

Would you like to set up a password for our engineers to use when visiting your home?

If YES, please provide a unique password of no more than 8 characters

Are you able to regularly read your meter?

Yes no

If NO, would you like us to carry out quarterly meter readings?

Are you visually impaired or blind?

If YES, would you like one of the following free of charge services?

Do you have a prepayment meter?

Yes No

If YES, do you need this moved so that you can top up and read the meter?

Would you like duplicate bills or statements sent to a third party representative? If YES, please provide the details of your third party representative below

Yes No

Full name

Telephone

Mobile

Email address

Relationship to you

You may also qualify for a free annual gas safety check. To be eligible for a free gas safety check you must be able to answer yes to ALL of the following questions

i Do you receive means tested benefits? ii Do you live in a property you own rather than rent? iii Has it been over 12 months since a gas safety check was carried out in your home?

You must also be able to answer yes to ONE of the following questions

i Do you live with a child under the age of 5? ii Are you a pensioner, disabled or chronically sick, living alone? iii Are you a pensioner, disabled or chronically sick, living with others who are either under the age of 18 or are also a pensioner, disabled or chronically sick?

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Did you know we offer a priority service register?

Register for priority service