NEA/Cadent One Number programme This referral form is for the sole use of Cadent employees or sub-contractors working for Cadent. Please note that NEA can only accept referrals from North London and Eastern network areas. If you are referring from the North West or West Midlands please refer via: https://groundwork.secure.force.com/vcmaenquiryform Cadent Gas network(Required)– Select –East AngliaEast MidlandsNorth LondonResidents DetailsClient's Title– Select –MrMrsMsMissDrClient's Name(Required) First Last Primary phone number(Required)Secondary phone numberAlternative contactThis could be a carer/family member/social worker, etc.Address(Required) Street Address Address Line 2 City ZIP / Postal Code Tenure– Select –Private OwnerPrivate TenantSocial HousingName and contact details for landlord/housing associationDetails of person making the referralReferral Source(Required)– Select –CadentCMO (sub contractor)Name of person making the referral(Required) Referrer's Email(Required) Enter Email Confirm Email Phone(Required)Type of referralA referral due to a faulty/isolated gas appliance(s) which is 'immediately dangerous' YES NO Reason for disconnection– Select –Gas leakCO detectedAppliance affected Boiler Fire Cooker Pipe Work Warm Air Unit A referral for the servicing of an appliance(s) which is deemed 'at risk' due to lack of maintenance. YES NO Appliance affected Boiler Fire Cooker Pipe Work Warm Air Unit A referral for energy advice YES NO A referral for welfare benefits advice YES NO Please give details of the issue and the type of assistance required.Any other information useful for this submissionPlease confirm if the following have been left with the customer:Temporary Heater YES NO You selected No. Please give reason Temporary Hotplate YES NO You selected No. Please give reason Carbon Monoxide Alarm YES NO You selected No. Please give reason Consent(Required) I confirm that I have the householder’s consent to pass their details to National Energy Action (NEA)
