Application for the Job Centre Plus to arrange Water Direct | Get in touch

Please complete the online application form below. Alternatively, simply call 0345 6022 777 and we will make the application on your behalf.

The asterisk (*) symbol denotes required fields.

First name - Person receiving benefit *

Please enter a valid first name - person receiving benefit

Surname - Person receiving benefit *

Please enter a valid surname - person receiving benefit

House/Flat Name/Number *

Please enter a valid house/flat name/number

Road / street name *

Please enter a valid road / street name

Town

Please enter a valid town

City

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County

Please enter a valid county

Postcode *

Please enter a valid postcode

Email address *

Please enter a valid email address

STW Account number

Please enter a valid stw account number

National Insurance Number *

Please enter a valid national insurance number

Bill payer name if different from above

Please enter a valid bill payer name if different from above

Date of Birth *

Please enter a valid date of birth

Home Telephone Number (including STD)

Please enter a valid home telephone number (including std)

Mobile number (if applicable)

Please enter a valid mobile number (if applicable)

Benefits received (please select) *

Please select a title

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