SCM Online referral agent registration
PRIVACY NOTICE
In brief, we'll keep the personal information you provide on this form safe on our online database and admin systems for 2 years after you last refer someone to the service. We'll only use your information in connection with your use of the Basics Bank service.

You can read our full Privacy Notice for Referral Agents by clicking the link below:
http://www.southamptoncitymission.co.uk/wp-content/uploads/2018/05/Privacy-Notice-BB-Referral-Agents.pdf

What type of registration does your organisation require? *
Online referral agents can check eligibility and issue vouchers for clients online, with the option to print the voucher themselves if required. There is no charge for online referral agents. Referral agents using paper vouchers have to pre-order vouchers from the SCM office in batches of 25 or more at a cost of 50p per voucher. They must phone the Basics Bank mobile to check eligibility before issuing a paper voucher.
Organisation/Charity Name *
Your answer
Department (optional)
For example, if your organisation is Sure Start, your department will be your centre e.g. Thornhill
Your answer
First name *
Your answer
Surname *
Your answer
Email address *
Your answer
Business address *
Your answer
Postcode *
Your answer
Work phone number *
Your answer
Mobile phone number (optional)
Your answer
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