Energy Advice and Support Referral

Supporting households through fuel poverty across Surrey and East Hampshire | Support our Cause

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About
Support
Partnerships
Resources
Our Impact
Latest News
- Energy Advice Tips
Contact Us

Energy Advice and Support Referral

Get in touch with our team for energy support.

Please note we can only assist if you live in parts of Surrey or in East Hampshire.

First Name

Last Name

Postcode

Telephone

Preferred Method of Contact

Email SMS Telephone Direct Mail

How many adults in your household?

How many Children in your household?

Name of Referral Agency supporting your application

Contact details of Referral Agency

Supporting statement

Please confirm if the following statements are true:

I have a pre-payment meter I receive a bill for my electricity and/or gas I have a smart meter for my gas I have a smart meter for my electricity

Who is your energy supplier for Gas?

Who is your energy supplier for Electricity?

Please tick the following statements that apply to you

I receive a means-tested benefit I receive a health-related benefit

Please note: We prioritise households that may be in a vulnerable situation. Please tick the following statements that applies to you. (You may be required to supply evidence)

I have a health condition made worse by the cold I have been affected by domestic abuse I am a care leaver living independently for the first time I have a long term health condition I live in a hard to heat home English is not my first language

Are you happy for Energy Manage to send you energy advice and information?

Yes No

Struggling with Energy Bills? We're Here to Help.

Registered Address

C/O SiGNAL – Unit 9, Suite D Suite 300 Oakhanger Business Park Bordon Hampshire GU35 9JA

Energy Manage (Community) CIC is a Community Interest Company registered in England

Company No. 14963539

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