Alteration Application All sections of this form need to be completed in order for us to process your application. If you need help filling out this form, please call a member of the team on 0870 300 7677 between the hours of 8AM-6PM, Monday to Friday Step 1 of 3 33% This form is for non-commercial customers only or those enquiring about multiple properties of four or less. If this isn’t you please take a look at our Business Connections pages.Your DetailsThis is the address where correspondence will be sent, if different from the site addressTitle:*MrMrsMissMsDrContact name:*Company name (if applicable):Correspondence Address* Street Address Address Line 2 City County Postcode Email Address: Telephone Number:*Mobile Number:Keeping in touchPlease let us know how you would prefer to be contacted:* Telephone Email Text Post The questions below allow us to correctly set the VAT for the quotationIn what capacity are you acting?:*OwnerOccupierLandlordArchitectDeveloperSelf-builderConsultantHousing AssociationLocal AuthorityIf the property is rented, do you have permission for a new gas connection to be installed?:*YesNoNot applicableAre you VAT registered?:*YesNo Site detailPlease use the address where you would like the alteration to be madeName of site contact:*Company name (if applicable):Is your site address the same as your correspondence address? (If 'yes' you don't need to complete the address field below.* Yes No Don't know Site Address Street Address Address Line 2 City County Postcode AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Email Address: Telephone Number:*Mobile Number:Keeping in touchPlease let us know how you would prefer to be contacted?:* Telephone Email Text Post Why do you need an alteration to your gas supply?For example, extension to property, kitchen conversion etc Scheduling the workWhat is the earliest date we can start to work on site?:* DD MM YYYY Property typeThis section gives us specific details regarding the propertyWhat is the type of property?:*TerraceSemi-detachedDetachedFlatIf your property is a Flat, please specify the floor level:Is the building Grade Listed?:*YesNoIs there anything else that might affect the way we carry out the work?:*Walls are thicker than normalParking restrictionsConservation area Meter and meter box detailsWhat sort of meter do you have?:*Credit meterPrepayment meterNo meterWhat is your meter point reference number?:*If you can’t find this number on your meter, contact your gas supplier and they will be able to tell youAre you able to access your ECV (Emergency Control Valve) to turn it off?:*YesNoWill you require a new meter box?:*YesNoIf YES, please indicate which type?:Surface-mountedSemi-concealedBuilt-inPlease note: we do not supply or install built-in meter boxesMeter LocationWhere is your meter located?*Kitchen CupboardUnder stairsLoungeGarageOutsideIf your meter is outside, what type of box do you have?:Surface-mountedSemi-concealedBuilt-inPlease upload a sketch of your property.*This must include: a) The road name b) Your current meter position (use an ‘x’ to show this) c) Your proposed meter position (use an ‘m’ to show this) d) The distance in metres between ‘x’ and ‘m’ – always round UP to the nearest metre e) Any important features like garages, porches, conservatoriesOn-site excavationsWill you be doing your own digging?:*YesNoReconnecting your meterPlease let us know which reconnection option you would like, following your alteration:*No reconnectionPartial reconnectionFull reconnection Your feedback is important… Once we’ve finished, you may receive a survey through the door asking you to let us know how the work went. This may be sent from our industry regulator, Ofgem, or direct from us. All feedback helps us to improve our customer experience so even if you don’t receive a survey, we’d still love to hear from you. Please call us on 0870 3007677, or you can email your feedback to email@example.com Submitting your form..… By submitting your application, you agree to Northern Gas Networks processing your personal data for the purpose of processing your application. If you accept our quotation, on completion of the work we may also share your personal information with a nominated third party which may send you a postal customer satisfaction survey to complete in accordance with Ofgem’s customer satisfaction survey procedure. Your personal data will be processed and stored in accordance with the Data Protection Act 1998.