Customer Service > Electronic Billing Information Service - Registration Form

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Company Details
Company Name
Company Address

(Please provide MPRN Number for each included site)
MPRN Number	MPRN Number
(Please provide additional MPRN Numbers on a separate sheet)

User Detail
I request access to the EBIS Extra Service. I have read Terms and Conditions for use of the EBIS Extra Service below and agree to use the service subject to these Terms and Conditions. You will receive an email when your bill is available online.
	User 1	User 2
Name
Title
Tel
Email
Signature
	I do not wish to receive email notification	I do not wish to receive email notification
Company Authorisation
Signed on behalf of the Company		date
Title
I understand and accept the terms and conditions