Skip to content
0808 169 9924
Request a call back
Please enable JavaScript in your browser to complete this form.
Please enable JavaScript in your browser to complete this form.
Are you completing this form on behalf of someone else?
*
Yes
No
Who would you like to receive the call back?
*
Yourself
The applicant
Your details:
Your first and last name (required)
*
Example: John Smith
Your email (required)
*
Example: John.doe@email.com
Your phone number (required)
*
Example: 01234567891
Your house number / name and street name (required)
*
Example: 45 Western Road
Your town (required)
*
Example: Manchester
Your county (required)
*
Example: Lancashire
Your postcode (required)
*
Example: CA14 3YJ
Name of the organisation you work for (if applicable)
Example: Energy Saving Trust
Your relationship to the applicant (required)
*
Example: Wife
Layout
Applicant details:
Applicant’s first and last name (required)
*
Example: John Doe
Applicant’s email (required)
*
Example: john.doe@email.com
Applicant’s phone number (required)
*
Example: 01234567891
Applicant’s house number/name and street name (required) (copy)
*
Example: 45 Western Road
Applicant’s town (required)
*
Example: Manchester
Applicant’s county (required)
*
Example: Lancashire
Applicant’s postcode (required)
*
Example: CA14 3YJ
Layout (copy)
How did you hear about us? (required)
*
Please select one
Event
Newspaper
Online article
Outdoor advertising (public transport, billboard, poster)
Partner Briefing
Previous contact
Radio
Search engine
Social media
Take Charge leaflet
Other
Please state (required)
*
How can we help? Please select from the dropdown below the option that applies to you (required)
*
Please select one
I need help with my energy bills
I need advice on how to reduce my energy bills
I’m looking for financial support
I’d like to know more about funding for home energy improvements
I would like help/advice about making my home more energy efficient
Would you like the applicant be added to our free Extra Care register - for extra care in a power cut? (required)
*
Yes
No
Would you like to be added to our free Extra Care register - for extra care in a power cut? (required)
*
Yes
No
Privacy Policy Agreement (required)
*
I Agree
Electricity North West funds the Take Charge Advice Service. We are working in partnership with Citizens Advice in the North West to provide you with this service. By submitting this form, your information will be shared with Citizens Advice in the North West, who will contact you. If you have selected to opt-in to the Extra Care service, Electricity North West will contact you regarding this.
If you are completing the form on behalf of someone else, you must have permission to do so.
Please see our full privacy policy available at
Privacy Policy (enwl.co.uk)
or by writing to
dataprotection@enwl.co.uk
Submit
0808 169 9924
Home
What’s on offer
Partner with us
Get in touch
Home
What’s on offer
Partner with us
Get in touch
