Request for energy advice form
Thank you for contacting Citizens Advice Staffordshire South West. Your issue is important to us; to enable us to give you the best advice please complete the following form.

We will use the information you provide in your enquiry to provide you with advice and if appropriate direct you to the right service. By choosing to include any "Special Category Data" (including but not limited to information about your health, ethnicity or trade union membership) you are consenting to us using this information for this purpose. For more information about how we use your information, please see our privacy policy:
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Email *
Is your issue about energy? *
Are you submitting this form on behalf of someone? *
If you have answered Yes, please tell us your name and who you are (e.g. relative, doctor, practitioner) and contact details. Please note, we can only give YOU information or signposting. We cannot give YOU full advice without authorisation from the person concerned.
Are you submitting this form from our website *
Name (person requiring advice) *
Postcode *
Date of birth *
Phone number we can contact you on (person requiring advice). *
can we leave a message *
Tell us about your needs and circumstances in as much details as possible.  This will help us make sure you receive the correct help quickly.
Please tell us if you've done anything so far to try to deal with your problem.
Are there any important deadlines, e.g. a bill, court date?
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