Priority Services Register application form
Title First name Last name
Phone number Alternative no.
How do you want us to contact you during a power cut?
Call me Text me
If you or someone you know, want to be added to our register, please complete the information
below then detach the form and post (free of charge, no envelope or stamp needed) to:
Priority Services, UK Power Networks, Fore Hamlet, Ipswich, IP3 8AA.
or email us at: firstname.lastname@example.org We will then contact you with further details.
An online version of this form is also available at www.ukpowernetworks.co.uk/priority
Reasons for inclusion I am dependent on medical equipment I am chronically sick I am disabled
I am blind or visually impaired I am deaf I have a young baby
I run a nursing or residential home I am elderly