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Contact Information
Name*

First NameLast Name
Business Name*
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Utility Details
Current Electricity Supplier
Current Gas Supplier
MPRN
GPRN
Recent Meter Reading (Electricity)
Recent Meter Reading (Gas)
Estimated Annual Electricity Usage (kWh)
Estimated Annual Gas Usage (kWh)
Billing and Payment
Preferred Payment Method: (Select one)*

Direct DebitBank TransferCashOther
IBAN (for Direct Debit)
Referral Program
Were you referred by someone? If yes, please provide their name or referral code:
Additional Comments or Questions
Consent*

I agree to the terms and conditions as outlined by Dolphin Utilities.
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Personal Information
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
Date
Nationality*
Residential Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Information
Business Name*
Business Type*
Trading Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone Number*
Please enter a valid phone number.
Annual Business Turnover
Banking Information
Bank Name*
Account Holder Name*
IBAN*
BIC/SWIFT Code
Additional Information
Upload Current Merchant Bill *

Cancelof
Additional Notes or Requirements
How did you hear about us?*
Consent*

I hereby confirm that the information provided above is true and accurate. I consent to Dolphin Utilities or its payment processing partners contacting me regarding this application and conducting any necessary credit or identity checks.
Should be Empty:

Contact Information
Name*

First NameLast Name
Business Name*
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Utility Details
Current Electricity Supplier
Current Gas Supplier
MPRN
GPRN
Recent Meter Reading (Electricity)
Recent Meter Reading (Gas)
Estimated Annual Electricity Usage (kWh)
Estimated Annual Gas Usage (kWh)
Billing and Payment
Preferred Payment Method: (Select one)*

Direct DebitBank TransferCashOther
IBAN (for Direct Debit)
Referral Program
Were you referred by someone? If yes, please provide their name or referral code:
Additional Comments or Questions
Consent*

I agree to the terms and conditions as outlined by Dolphin Utilities.
Should be Empty:

Personal Information
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
Date
Nationality*
Residential Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Information
Business Name*
Business Type*
Trading Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone Number*
Please enter a valid phone number.
Annual Business Turnover
Banking Information
Bank Name*
Account Holder Name*
IBAN*
BIC/SWIFT Code
Additional Information
Upload Current Merchant Bill *

Cancelof
Additional Notes or Requirements
How did you hear about us?*
Consent*

I hereby confirm that the information provided above is true and accurate. I consent to Dolphin Utilities or its payment processing partners contacting me regarding this application and conducting any necessary credit or identity checks.
Should be Empty:

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