Claim Form - Electricity

Name

Address

Phone nr at home or cell

Phone nr at home or cell :: In order to deail with your complaint rapidly, it is important for Aqualectra to have the telephone number where you can be reached during office hours.

Phone nr at work

Phone nr at work :: In order to deail with your complaint rapidly, it is important for Aqualectra to have the telephone number where you can be reached during office hours.

E-mail address

Meter number

Details

Date of the failure

Date of the failure :: Without the date and the time of the failure, Aqualectra Distribution can not deal with the problem.

Time of the failure

Time of the failure :: Without the date and the time of the failure, Aqualectra Distribution can not deal with the problem.

Description of the failure

Other Appliance

For questions, please call Cunningham Lindsey at 7270733