Contact Name:

Business Name:

Business Address:

Post Code:

Tel No:

E-Mail:

Name of your Current Water Supplier:

	Water Usage or Cost per:
Monthly

Quarterly

	Sewerage Usage or Cost:
Monthly

Quarterly

	Are you paying on Water Rateable Value?:
Yes

No

	Are you paying on Water Meter Usage?:
Yes

No

Nature or Type of Business:

Number of People on Site:

Annual Spend:

	Is your business a Large consumer of Water:
Yes

No

Comments

Any additional Information which may assist our search on your behalf: