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          Citizens Advice Energy Advice Referral Form
Citizens Advice Surrey Heath is offering residents support through a new energy advice project which aims  to help tackle fuel poverty. If you would like an energy appointment please complete the form below
 
Please note that we can normally only help clients who live or work in the Surrey Heath area. If you do not live in Surrey Heath, you can find your closest local Citizens Advice office here:
www.citizensadvice.org.uk/about-us/contact-us/#h-find-your-nearest-citizens-advice

We need to record information about you to help with your enquiry. We have a legitimate interest to do this.
We will not share your information with anyone outside our organisation without your express permission. Please let us know if you'd like more information about how we will use your information, or visit https://www.citizensadvicesurreyheath.org.uk/privacy-security/

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Name *
Contact telephone number *
Email address
Postcode
 *
Have you contacted Citizens Advice previously?
 *
Which of the following would you like advice on (please select all that apply)
 *
Required
If you have selected emergency energy top-up above, please provide details of your current balance - we aim to contact anyone with less than £5 credit within 2 working day
Please indicate your preference for either an office or telephone appointment 
 *
We can only offer appointments during office hours - please indicate your availability for the following times, please allow up to one hour for an appointment
 *
Required
Thank you for completing the form, we aim to respond within the next 5 working days. 
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