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Apply for LPG Bottled Supply (Residential)

Either complete this form or phone 0800 84 12 12 to apply for bottled (cylinder) LPG supply to your home.

On receipt of your application, we will:

1. Check your site is within our delivery range.

2. Contact you on your daytime contact number to make sure your home is accessible for bottle deliveries (according to the LPGA Code of Practice), do a free site check if necessary, inform you of our rates and answer any queries to help make this as easy as possible.

3. Confirm your application by providing a unique customer number to refer to when you re-order, and send you a pack with information on our terms and conditions, safety hints, how to read the regulator, and payment options.


1   SUPPLY DETAILS

*
eg:(22/08/2008)

Gas used for* Hot Water Heating
  Cooking Central Heating
Regulator Kit Required‡
‡Gasfitter will be invoiced directly.		 (Delivered with OnGas bottles)

2  CUSTOMER DETAILS

    Mrs   Mr   Other

Full Name of account holder*


(if different from above)




Are you the: Property Owner    Tenant

If tenant, please state Landlord’s details (if known)

Name

Mobile

Daytime Ph

 

3   GASFITTER/CONNECTION AGENT DETAILS
(if applying on a customer’s behalf)

Business Name & Location *

Contact Person *

Daytime Phone *

Referrer Code

Promo Code/Ref

*mandatory fields