Hyde Housing Referral Referrer's DetailsName(Required) First Last Organisation(Required) Phone(Required) HiddenPhone(Required)Email(Required) Enter Email Confirm Email Client's DetailsName First Last Client's date of birth(Required) Day Month Year Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone(Required) HiddenPhone(Required)SupportReason for referral(Required) Energy Hardship Fund or Top-up voucher-request (pre-payment meter) Energy Advice Both File UploadAttach eligibility documents including your/your client’s latest fuel statement here. Drop files here or Select files Max. file size: 10 MB. Additional informationIf there is any other information you think we should be made aware of please include it here. Please include information about the issue, any progress or actions already taken, any known deadlines or any sensitive matters to be aware of.GDPRBy 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.(Required) I agree to the information above CAPTCHA
