Warm and Safe Homes Referral

Warm and Safe Homes Referral

Referrer's Details
Name
First Last
Organisation
Phone*
Email
Client's Details
Name
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Support
What type of support do your clients need?*
- Select All
- Energy Advice
- Benefits Advice
- Water Debt Advice
File Upload
Attach eligibility documents including your/your client's latest fuel statement here.
Drop files here or
Additional information
If there is any other information you think we should be made aware of please include it here.
GDPR
By ticking the box below you confirm that:
• The client has given their permission for you to pass their information on to NEA.

• You have explained the purpose of doing so and made the client aware that their information will be used by a member of the team to contact them.

• You are processing the client’s data lawfully.

• You are aware your personal details will be kept by NEA for the purposes of completing this referral.

• Any information you supply below will be stored and processed according to NEA's privacy notice
Please tick this box to confirm your understanding of the above.*
- I agree to the information above

Referrer's Details