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Fuel

Gas
Electricity
Dual Fuel

GAS

MPRN

Contract Start Date

Standing Charge

Unit Charge

Contract End Date

12 Month

24 Month

36 Month

48 Month

60 Month

Other

New Connection

AQ

Business Details

Business Name

Business Type

Landline No. :

Email :

Name On Bill :

Paper Bill :

Yes

No

Property Ownership :

Freehold

Lease

Customer Ref Id :

Unique Id :

Unique Name :

Supply Name :

Company Reg. No. :

Mobile No. :

Registered Company Name :

Micro business :

Yes

No

Domestic Customer :

Yes

No

Vulnerability Indicator :

Yes

No

Site Address

Address1

City :

Address2

Post Code :

Business Details

Same as site Address

Address1

City :

Vulnerability Indicator :

Monthly

Quarterly

Address2

Post Code :

Primary Contact detail

Business Type

Primary First Name :

Primary Last Name :

Primary Phone No :

Primary Email Id :

Energy Account Manager (For day to day running of the account)

Name :

Mobile No. :

Email Address :

Phone No. :

Payment Details

Vulnerability Indicator :

BACS

Variable Direct Debit

Card

Fixed Direct Debit

Account Name :

Sort Code :

Card No. :

Payment Term Days :

Fixed DD Days :

Account Number :

Account Name :

Fixed DD Amount :

Partner Details

Partner Name :

Additional Email for Notifications :

Commission Type :

Fixed Uplift

Gas Fixed Commission(Uplift per Unit) :

(p/KWH)

Gas SC Fixed Commission(Uplift per Day) :

(p/Day)

Group Details

Group Name :

Electricity

Full Mpan :

Contract Start Date :

Standing Charge :

(p/Day)

Day Unit Charge :

(p/KWH)

Night Unit Charge :

(p/KWH)

EWE Unit Charge :

(p/KWH)

Capacity Charge :

(p/KVA)

Excess Capacity Charge :

(p/KVA)

EMR Charge :

(p/KWH)

Energization status

RHT Meter

Customer's Third party MOP Contract

Customer's Third party DA/DC Contract

Contract End Date :

12 Month

24 Month

36 Month

48 Month

60 Month

Other

Day EAC :

(KWH)

Night EAC :

(KWH)

EWE EAC :

(KWH)

Site Capacity :

(KWH)

Reactive Charge :

(kVArh)

FIT Charges :

(p/KVA)

New Connection

MOP/DC/DA Use ISTA

Business Details

Business Name

Business Type

Landline No.

Email

Name On Bill

Paper Bill

Yes

No

Property Ownership

Freehold

Lease

Customer Ref Id

Unique Id

Unique Name

Supply Name

Company Reg. No.

Mobile No.

Registered Company Name

Micro business

Yes

No

Domestic Customer

Yes

No

Vulnerability Indicator

Yes

No

Site Address

Address1

City :

Address2

Post Code :

Billing Address

Same as site Address

Address1

City :

Billing Term Type :

Monthly

Quarterly

Address2

Post Code :

Primary Contact detail

Primary Title

Primary First Name :

Primary Last Name :

Primary Phone No :

Primary Email Id :

Energy Account Manager (For day to day running of the account)

Name :

Mobile No. :

Email Address :

Phone No. :

Payment Details

Payment Method :

BACS

Variable Direct Debit

Card

Fixed Direct Debit

Account Name :

Sort Code :

Card No. :

Payment Term Days :

Fixed DD Days :

Account Number :

Bank Name :

Fixed DD Amount :

Partner Details

Partner Name :

Commission Type :

Fixed Uplift

Electricity Day Fixed Commission(Uplift per Unit) :

(p/KWH)

Electricity Night Fixed Commission(Uplift per Unit) :

(p/KWH)

Electricity SC Fixed Commission(Uplift per Day) :

(p/Day)

Electricity EWE Fixed Commission(Uplift per Unit) :

(p/KWH)

Group Details

Group Name :

Group Details

Full Mpan :

Contract Start Date :

Standing Charge :

(p/Day)

Day Unit Charge :

(p/KWH)

Night Unit Charge :

(p/KWH)

EWE Unit Charge :

(p/KWH)

Capacity Charge :

(p/KVA)

Excess Capacity Charge :

(p/KVA)

EMR Charge :

(p/KWH)

Energization status

RHT Meter

Customer's Third party MOP Contract

Customer's Third party DA/DC Contract

Contract End Date :

12 Month

24 Month

36 Month

48 Month

60 Month

Other

Day EAC :

(KWH)

Night EAC :

(KWH)

EWE EAC :

(KWH)

Site Capacity :

(KVA)

Reactive Charge :

(kVArh)

FIT Charges :

(p/KVA)

New Connection

MOP/DC/DA Use ISTA

GAS

MPRN

Contract Start Date

Standing Charge

Unit Charge

Contract End Date

12 Month

24 Month

36 Month

48 Month

60 Month

Other

New Connection

AQ

Business Details

Business Name

Business Type

Landline No. :

Email :

Name On Bill :

Paper Bill :

Yes

No

Property Ownership :

Freehold

Lease

Customer Ref Id :

Unique Id :

Unique Name :

Supply Name :

Company Reg. No. :

Mobile No. :

Registered Company Name :

Micro business :

Yes

No

Domestic Customer :

Yes

No

Vulnerability Indicator :

Yes

No

Site Address

Address1

City :

Address2

Post Code :

Billing Address

Same as site Address

Address1

City :

Billing Term Type :

Monthly

Quarterly

Address2

Post Code :

Primary Contact detail

Primary Title

Primary First Name :

Primary Last Name :

Primary Phone No :

Primary Email Id :

Energy Account Manager (For day to day running of the account)

Name :

Mobile No. :

Email Address :

Phone No. :

Payment Details

Payment Method :

BACS

Variable Direct Debit

Card

Fixed Direct Debit

Account Name :

Sort Code :

Card No. :

Payment Term Days :

Fixed DD Days :

Account Number :

Bank Name :

Fixed DD Amount :

Partner Details

Partner Name :

Additional Email for Notifications :

Commission Type :

Fixed Uplift

Gas Fixed Commission(Uplift per Unit) :

(p/KWH)

Electricity Night Fixed Commission(Uplift per Unit) :

(p/KWH)

Electricity SC Fixed Commission(Uplift per Day) :

(p/Day)

Electricity Day Fixed Commission(Uplift per Unit) :

(p/KWH)

Electricity EWE Fixed Commission(Uplift per Unit) :

(p/KWH)

Gas SC Fixed Commission(Uplift per Day) :

(p/Day)

Group Details

Group Name :

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