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Dee Valley Water plc

Registered Office:
Packsaddle
Wrexham Road
Rhostyllen
Wrexham LL14 4EH

Registered in England & Wales No. 3527628


 

Application for Additional Services

 

  
  Personal Details  
  Name
  
  Telephone E-mail  
 

 

  
  Address Information  
 

Address





Postal Code


  
  Billing Details  
 

Billing Reference

Click to show how to find billing reference

 
  Additional Information  
Are you or anyone who lives with you blind or have difficulty with sight?
Are you or anyone who lives with you deaf or have difficulty with learning?
Do you or anyone who lives with you have a physical disability which restricts your movement?

If so, please state your disability
Do you or anyone who lives with you have kidney dialysis at home?
Additional Services
Password Scheme
I wish to join the Password Scheme and my choice of password is:
Redirection Callers
I wish to join the Redirection of Callers Service and the person who has agreed to check the identification of callers on my behalf is:
(Please Note: This person must sign to accept responsibility)
Name

Address





Postal Code

Signature

(Please Note: This person must sign to accept responsibility)
Redirection Bills
I wish to join the Redirection of Bills Service and the nominated person is different from above:
(Please Note: This person must sign to accept responsibility)
Name

Address





Postal Code

Signature

(Please Note: This person must sign to accept responsibility)
Audio Bills
I wish to receive my bills on audio cassette (tick if required)
Braille Bill Service
I wish to receive my bill in Braille
Large Print Service
I wish to receive my bill in Large Print
Meter Re-sitting Service
Are you registered physically disabled and find it difficult to read your meter?
Do you want us to contact you to discuss the option of having your meter re-sited?
Your Water Supply
If you have hearing difficulties and would find difficulty hearing the message given out with a loudhailer in an emergency, would you like us (please tick one box)

Visit you?

Put a card through your letterbox?
Your Water Supply
Do you or anyone who lives with you require a constant water supply?
If yes, please give details
Audio Cassettes
1) Additional Services
2) Should I have a Water Meter
3) How we Handle Your Complaints
4) Code of Practice for the Collection of Unpaid Charges from Household Customers
Declaration
I agree that the information provided in this application form may be held and used by Dee Valley Water (and its authorised employees and agents) to provide the services I have applied for.