Priority Services Form

Priority & Special Services Registration

You can register as a Vulnerable Customer if you or someone living in your household are critically dependent on electrically powered equipment for independent living. Likewise, you can register for our priority services due to advanced aged (66 or over) or for reasons of physical, sensory, intellectual or mental health.

Please complete the online form below to register as a Vulnerable Customer and/or nominate a third-party representative to manage your PrepayPower account. You can also download the form here and email it to priorityservices@prepaypower.ie. Or call 0818 919 487 to request a paper form and stamped addressed envelope.

Important Information: Your doctor may be asked to provide evidence of your use of the electrical equipment listed below. Please find our Vulnerable Customer Codes of Practice.

First Name*

Last Name*

Your Date of Birth

Mobile Number*

Email*

Last 6 Digits of PrepayPower Card Number*

Your Address

Address Line 1

Address Line 2

City/Town

Eircode

What products do you have with PrepayPower?

If you know your MPRN number, please enter it here

If you know your GPRN number, please enter it here

	Do you have any of the following Life Support Machines?
Oxygen Concentrator	Oxygen Concentrator
Personal Suction Pump	Personal Suction Pump
Peg Tube Feeding Pump	Peg Tube Feeding Pump
Total Perental Nutrition Machine	Total Perental Nutrition Machine
Ventilator	Ventilator
Home Dialysis	Home Dialysis
Other	Other

Do you have a battery backup for the listed Life Support equipment?

Please provide details of the equipment here

	Do you have any of the following NON Life Support Equipment?
Household Lift	Household Lift
Stair Chair	Stair Chair
Nebuliser	Nebuliser
Electric Hoist	Electric Hoist
Electronic Pressure Relieving Mattress	Electronic Pressure Relieving Mattress
Other (Please Specify Below)	Other (Please Specify Below)

Do you have a battery backup for the listed Non-Life Support equipment?

Please provide details of the equipment here

	Mobility
Arthritis	Arthritis
Wheelchair Bound	Wheelchair Bound
Paraplegic	Paraplegic
Quadriplegic	Quadriplegic
Artificial Limbs	Artificial Limbs
Other	Other

Please provide details of the Mobility Vulnerability here

	Age
I am aged 66 or over and live alone, with minors or other elderly people	I am aged 66 or over and live alone, with minors or other elderly people

	Sight or Hearing Impaired
Blind	Blind
Partially Sighted	Partially Sighted
Deaf	Deaf
Hard of Hearing	Hard of Hearing
Other	Other

Please provide details of the Sight/Hearing Vulnerability here

Would you like an alternative person to manage your account?

Alternative Person

If you would like to have an alternative person nominated to manage your account, that's no problem at all! Simply fill in their details below. We'll send them a message then to confirm they're nominated to manage your account.

First Name of Nominated Person*

Last Name of Nominated Person

Email of Nominated Person*

Mobile Number of Nominated Contact*

How would you like to be contacted?

SMS

Phone

Post

I agree to the Priority Services terms.

In completing this form you agree to share this infomration with ESB Networks. This allows ESB Networks to provide you with additional services to suit your customer category.

I have completed form with all relevant information.

Priority & Special Services Registration

Alternative Person

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