Your details
Opus Energy account number
*
Your business name
Title
*
Mr
Mrs.
Miss
Ms.
Lord
Lady
Sir
Prof.
Dr.
Mr.
First name
*
Surname
*
Contact number
*
Email address
Move out date
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
Forwarding address building name / number
Forwarding address street name
Forwarding address town
Forwarding address postcode
Property details
Building name/number
*
First line of address
*
Town
Postcode
*
Electricity meter read(s) on the day you moved out - if applicable
Gas meter read(s) on the day you moved out - if applicable
Landlord/Managing Agent details
Landlord/Managing agent business name - if applicable
Landlord title
*
Mr
Mrs.
Miss
Ms.
Lord
Lady
Sir
Prof.
Dr.
Mr.
Landlord first name
*
Landlord surname
*
Landlord/managing agent contact number
Landlord/managing agent email address
Customer declaration
*
I can confirm that the information provided in this form is accurate and accept that I can be held accountable for charges for any period should new information be provided at a later date.