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You are here : Draft - Erica

Watersure and Lift

Please complete the below fields

Fields marked with * are mandatory.

Contact details

Customer number (e.g. 1234567-8)
Name
Address
Postcode

LIFT

 

To apply for the Low Income Fixed Tariff please tick the box below that matches your circumstances.

Please also provide a photocopy of your supporting document to show receipt of the qualifying benefit or low income.








Document upload

Watersure

To apply for the Watersure tariff please tick the box below that matches your circumstances.

 

Large family with three children under the age of 19 in full time education and in receipt of child benefit
Please state the full name and dates of birth of the children
Medical condition that requires use of extra water
Please state the name of the medical condition
Please also tick the box below that matches your circumstances and provide a photocopy of your supporting document to show receipt of the qualifying benefit.







Supporting documents

Declaration

The information I have given is correct to the best of my knowledge and I understand that Affinity Water may need me to provide further evidence of my income and/or benefits in the future. I confirm that if my circumstances change and I’m no longer eligible I will update Affinity Water. I understand that to receive these tariffs I must make payments.
   

For water supply emergencies 24/7

If you are a business or retailer please call us on 0345 357 2407.

Broken Apparatus | Loss of supply | Operational Incidents | Water disruption | Water pressure | Water quality problem

Please do not email in an emergency as we want to be able to help you as quickly as possible.

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