Lemon Aid External Agency Low Energy Applicance Referral FormPlease enable JavaScript in your browser to complete this form.Referring Agency DetailsPlease Select Your RegionNorth AyrshireEast AyrshireDumfries & GallowayReferring 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 Family SizeCustomer Income DetailsEmployedBenefitsPensionIn What Way Would You/Customer Benefit From One Of The Low Energy Applicance Available?Please provide as much detail as possibleWhich Low Energy Applicance Would You Benefit From Most?MicrowaveAir FryerSlow CookerIs the customer currently off supply?YesNo Do you currently have arrears with your energy supplierYesNoAccomodation DetailsRented PropertyOwner/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