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Partner Referrals
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Complete the referral form and one of our team will get in touch
Referring agency
Name of referrer
Contact details of referrer
Customer name
Customer address (inc postcode)
Customer mobile
Customer email
Please tick the following statement(s) that apply to the customer:
Receives a means-tested benefit
Receives a health-related benefit
Has a health condition made worse by the cold
Reason for referral
Fuel voucher request
Energy and/or water debt
Energy advice and support (one-to-one)
Energy advice and support (group session)
Supporting statement
Are you happy for Energy Manage to send you information about our projects and latest updates?
Yes
No
Send message
Mail
info@energymanage.org.uk
Call us
07368 367 394
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Email
Message
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