Hippo bag request form

Please fill in this form with all your up to date details and click submit.

Note: The Hippo Bag may not be suitable for toilet cisterns that have less than 6.5ltr capacity or are dual flush.

(Please note that fields marked * are mandatory)

1. Your Details

Title*

First name*

Surname*

Age group*

Less than 20

21 - 30

31 - 40

41 - 50

51 - 60

61+

Property address*

Postcode*

Telephone number (inc. STD code)

Alternative telephone number

Are you a council tenant*

Yes

Email address

Customer details *

Domestic

Non Domestic

Unmeasured

Measured

Number Required (Max 3 per customer)

Any additional water saving devices at property? (tick box)
Number of dual cistern(s)
Number of water butt(s)
Other

How did you hear about Hippo Bags?
DCWW Publication	If so which one?
Internet Website	If so which one?
Event	If so which one?
Environmental Agency
Other

Click here to read our privacy statement to understand how we may use your personal information.

Having problems submitting your hippo bag request - Call us today on 0800 052 0145

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