Fill The Information Below

Sales Agent *

Customer Reffered by

On Date

Customer Status on Property

Move In

Renewal

Tricky C.O.T

Out of Contract

Business Name

Business Type

Business Address

Land Line No.

Reg No. (if LTD)

Move in Date

Contact Person

Date of birth

Contact Email *

Customer (Owner, Tenant)

Owner

Tenant

Home Address

Landlord Name

Contact Number *

Electricity Meter

Current Elec. Supplier

Consumption

Contract End Date

Name Appear on Bill

Customer Ref No.

Last Bill / Outstanding & Mode of Payment

Supply No.

Supply No.

Top Line
Bottom Line

Meter Serial No

Current Meter Read

Proposed Elec. Supplier

Supplier Name

Term

Rates

Annual Consumption

Current Rate

S.Charges
Day
Night
Wk.End

Offer Rates

S.Charges
Day
Night
Eve / Wk.End

Uplift

Document Attached

2nd Electric Meter Details:

Gas Meter

Current Gas. Supplier

Gas Consumption

Contract End Date

Name Appear on Bill

Last bill / Outstanding

Meter Serial No.

MPRN No.

Current Meter Read

Proposed Elec. Supplier METER 2

Supplier Name

Term

Rates

Gas Annual Consumption

Current Rate

S.Charges
U Rate

Offer Rate

S.Charges
U Rate

Uplift

Document Attachment

2nd Gas Meter Details:

Office: Lorem Ipsum

Call xxx-xxx-xxxx

Email:info@yourcompany.com

Site: www.yourcompany.com

Copyright 2024 . All rights reserved