Please enable JavaScript in your browser to complete this form.Referring Agency DetailsPlease Select Your RegionNorth AyrshireEast AyrshireDumfries & GallowayPlease Tell Us The Region of East Ayrshire You RepresentReferring Agency Name *Agency Contact Name *FirstLastEmail *Phone *Date of ApplicationToday's DateReferral MethodCustomers Details Name *FirstLastCustomer Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodeCustomer Phone *Customer EmailCustomer DOB:Customer Family SizePlease describe why you are referring the customer to Lemon Aid, please be as detailed as possible. *This area must be competed at all times for the referral to be accepted by Lemon AidIs the customer currently off supply?YesNoLandlord/Owner/OccupierReferrer NotesPLEASE NOTE BELOW ISSUES / ASSISTANCE REQUIRED FROM LEMONAID. LEMON AID CANNOT ASSIST WITH NEW TENANCY MOVE-INS. LEMON AID NO LONGER OFFER AN ENERGY SWITCHING SERVICE. IF THE REFERRAL RELATES TO ANY OF THESE AREAS WE WILL NOT BE ABLE TO CORRESPOND WITH THE REFERRED CUSTOMER.Signature *By typing your name in this box you are giving permission for the provision of information relating to my advice needs to the Citrus Energy Team. I understand and agree that all information given will be available to both of these parties at all times for the purpose of assisting me in my Energy bills.Date of SubmissionToday's DateSubmit
