I04 Reconnect supply

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I04 Reconnect supply

Request for reconnection of a supply which has been temporarily disconnected



Items marked * must be filled in.

1. Retailer details


2. *Supply Point details

Premises address


3. *Disconnection details

Type of disconnection

Temporary disconnection of water supply

Temporary disconnection of sewerage supply

Reason for disconnection

Non-payment

Non-Household Customer requested disconnection

Illegal use of water Services and / or Sewerage Services

Breach of water Fittings Regulations


4.*Reconnection details

Please note that where a reconnection is being undertaken following illegal use of water, or a breach of the water Fittings Regulations, the Wholesaler may need to undertake appropriate inspections prior to making the reconnection.

Where the reconnection was or will be carried out by an Accredited Entity, please confirm the Accredited Entity and provide the details requested below

5. Update following reconnection by an Accredited Entity

Meter 1 Meter 2 Meter 3
Date of reconnection
Date of meter reading
Meter read
Photograph of meter included

6. Non-Household Customer contact

Please indicate whether you give consent for the wholesaler to visit the premises without involvement of the Retailer ?

YesPlease provide contact details below

No

Customer Contact Details

Please indicate if you want to be notified of the date of the visit

Yes

No


7. *Declaration

By submitting this form I accept the standard terms for reconnection activity in accordance with the Wholesaler?s Wholesale Tariff Document.
For reconnection by the Wholesaler, if activity is for a standard reconnection in standard circumstances as priced in the Wholesale Tariff Document then it will take place without a quote being issued, and may take place on the first visit.
I hereby acknowledge and declare that the information provided in this form is correct and up to date at the date of submission.

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