Start Your Business Energy Claim

Client Company Name

Client Company Number (if applicable)

Company Address

Company Representative

Position

Mobile Number

Office Number

Email Address

Energy Broker Company Name

Broker Company Address

Are They Still Trading? Are They Still Trading? YES NO

Name of Account Manager

What did the Broker tell you about how they got paid?

Date of First Contact

On what date did the Broker move you to a new Energy Supplier

Name of Energy Company Switched To