Title * Select Mr Mrs Miss Ms
First Name*
Last Name*
Title Select Mr Mrs Miss Ms
First Name
Last Name
Unit Number*
Apartment Name*
Apartment Address*
Contact Number 1*
Contact Number 2
Email Address
Address of Correspondence - (If different from the apartment above)
Move in date (started tenancy)*
Number of occupants* Select 1 2 3 4 5 6 7 8 9 10
Relationship to the property* Select Owner Tenant Property Manager Other
Agency Name*
AGENT/OWNER CONTACT PERSON*
AGENT/OWNER PHONE*
AGENT/OWNER EMAIL*
Please, provide the reason*
Do you want your monthly statement / invoice emailed to you* Select Yes No
To read the EnergyCo direct debit letter, click here.To download a copy of the EnergyGo direct debit form, click here.
By submitting this application form, you confirm that the above particulars are true. You understand that we may use the information that you have provided to us for the purpose of deciding whether or not to accept your application and for purposes relating to the ongoing relationship between you and Energyco Limited (including debt recovery). You authorize us to use this information for these purposes and also to disclose it to any referee who you nominate and also to any credit reference agency we may approach. If you do not supply us with this information, which we request, we may be unable to adequately assess your financial standing, and may decline this application. You also authorize any such referee or credit reference agency to provide us with information, which we may require in order to assess your financial standing.
You have the right to request access to and correction of personal information, which we hold about you.
You acknowledge that you have read our Terms of Agreement and Pricing List on the reverse of this Application Form and agree to be bound by the terms and conditions.
