Lemon Aid Low Energy Applicance Referral Form (Client)Please enable JavaScript in your browser to complete this form.Customers Details Please Select Your RegionNorth AyrshireEast AyrshireDumfries & GallowayName *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 CookerAre you currently off supply?YesNo Do you currently have arrears with your energy supplierYesNoAccomodation DetailsRented PropertyOwner/OccupierSignature *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
