A. Your Brief Introduction (To Know you better and serve effectively, please provide your contact options) 1. Customer Account Number* (required) 2. Name On Bill* (required) 3. GSM Number (required) 4. Your Email* (required) 5. Name Of Occupier* (required) 6. OccupierGSM Number* (required) 7. Occupier Email* (required) 8. Owner Of Permise 9. Permise GSM Number* (required) 10. Permise Email* (required) 11. Billing Address Locality LGA State 12. If you would like to change the Name on Bill B. Estimation of your load and supply requirements (In order to establish a robust network to provide you with quality and uninterrupted power supply, please provide your information as requested below) 1. Daily Receive Power (Hours) 2. Timeslots when supply of electricity is most convenient / required 6am-10am10am-5pm5pm-10pm10pm-6am 3. What is the electricity supplyResidentialShopEateryBankHotelSchoolOfficeReligious Establishment used for in your premise 4. Brief description of connected fixtures and appliances(Please fill the no. of appliances in appropriate box) Bulbs Mixer/Grinder* Water Heater Fan Electric Cooker* Air Conditioner Refrigerator Television Pressing iron* Microwave Oven Other appliances C. Your Service Expectations (In order to understand your service needs and preferences, please provide the following details) 1. Please select options for receiving bills Delivery to houseDelivery by emailDelivery by textThrough Website 2. Mode of bill payment(Please check all preferred methods of payment) Cash at BEDC officeCash deposit at nearest bankChequePoint Of Sale Terminal (POS)Debit card/ATMOnline payment 3. Nearest bank branch to your premise 4. Do You have a meter at your premise YesNo 5. Metering type in your premise Prepaid MeterCredit Meter 6. Is your meter reading taken every month (In case of credit meter) YesNo 7. If "No", Interval of meter reading D. Existing Issues/complaints In order to understand the existing issues with the company, please provide a list of your complaints/issues within the last 6 months 1. Nature of issue/ complaints a) b) c) d) 2. Suggestions to improve our services 3. Name of customer/occupier 4. Signature: 5. Photo Of user/Occupier: 6.Date Company presentation how can we help you? Contact us at the BEDC office nearest to you for any technical complaint.