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:
Layout
Your full name
*
Your phone number
*
Your town
*
Your postcode
*
Name of the organisation you work for (if applicable)
*
Your email
*
Your street name
*
Your county
*
Your relationship to the applicant
*
Applicant details:
Layout (copy)
Applicant’s full name
*
Applicant’s town
*
Applicant’s postcode
*
Applicant’s phone number
*
Applicant’s street name
*
Applicant’s county
*
Applicant’s email
*
How did you hear about us?
*
Event
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
*
How can we help? Please select from the dropdown below the option that applies to you
*
I need help with my energy bills
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? *
*
Yes
No
Would you like to be added to our free Extra Care register - for extra care in a power cut? *
*
Yes
No
Privacy Policy Agreement
*
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
Get in touch
Home
What’s on offer
Get in touch
