Make a Referral

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Make a Referral

Please complete this form to make a referral to Citizens Advice Allerdale. We only accept referrals from external agencies through our website.

If you would like advice please call 01900 604735 or email [email protected]citizensadviceallerdale.org.uk There is also lots of information in the Get Help section of our website.

Referrers Name *

First

Last

Referrers organisation *

Referrers Email *

Referrers contact number *

What does the client require help with? *

Debt e.g. rent/mortgage arrears, council tax arrears, fuel arrears, credit cards, loans, catalogues, etc, Breathing Space, Benefits eg benefit forms, benefit check, benefit appeal, Housing eg eviction, disrepair, Notice Seeking Possession/Court Action, support to gain or maintain a tenancy, Grants/Hardship support for household starter kit, white goods, furniture, gas, electric

Please confirm that the client gives permission for their information, confidential or otherwise, regarding their case which may contain sensitive personal data to be shared electronically with Citizens Advice Allerdale: *

Yes, the client is happy for their information to be shared electronically with Citizens Advice Allerdale
No, the client is NOT happy for their information to be shared electronically with Citizens Advice Allerdale

Please confirm that the client gives permission for Citizens Advice Allerdale to discuss their case with the referring agency: *

Yes, the client gives permission for Citizens Advice Allerdale to discuss their case with the referring agency
No, the client does NOT give permission for Citizens Advice Allerdale to discuss their case with the referring agency

Clients Name *

First

Last

Clients DOB *

Clients Mobile Number *

Please note that calls made to clients will be from an unknown or withheld number. We will attempt to contact the client on three occasions. If we are unable to get through to the client after three attempts their case will be closed.

Clients Home Phone Number

Clients email

Does the client give permission for Citizens Advice Allerdale to:

Leave a voicemail
Send an SMS
Send a letter
Send an email

Clients Address & Postcode *

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Make a Referral

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