Vulnerable customer registration form

*Fields are mandatory

To register for priority or special services, please complete the relevant sections of the below form.

Customer details


Please provide your supply address


To find your Eircode visit https://finder.eircode.ie/#/ and type your full address into the search box.

Contact details


Account details


You can find your account number on your Irish Water bill.

Optional: Full name of vulnerable customer (if different to account holder)


Nominate an alternative contact


To find your Eircode visit https://finder.eircode.ie/#/ and type your full address into the search box.

Contact details


Special services register


Do you wish to register you or somebody in your home for special services?

How would you describe the person registering for special services? (please check all boxes that apply).

Services for blind or vision impaired customers


Please indicate the format that you wish to receive your bill:

Priority services register


Do you wish to register you or somebody in your home for priority services (for those critically dependent on water for a medical condition).

This register will allow us to identify customers in most need of priority services. To help us ensure we meet that commitment, we may seek proof of your medical condition.

Consent


Irish Water may share registration information with authorised agents or third parties who act on behalf of Irish Water to enable us to provide the services set out in this Code. By providing this information to Irish Water, the account holder agrees that it may be used by Irish Water in this manner. View Irish Water’s Data Protection Notice here.

Where the vulnerable customer is not the account holder, the account holder confirms he/she has the consent of the vulnerable customer to provide their personal data (if this has been provided), strictly for the purposes set out in this Code.

The account holder confirms that he/she has the consent of any third party who is acting on their behalf to provide that person’s information, including contact details, to Irish Water.

By clicking the send button you are agreeing to us and/or our agents contacting you regarding this form.

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