FoodbankEnergy – Fortis Advisory CIC

Energy Top-up request (Foodbank user)

Energy Topup Request Form

Do you have a prepayment meter?

Yes

Please note: at the end of the form you will be asked to upload or take a picture of your energy meter and proof of your name and address, which can be a letter or drivers licence.

Sorry, energy help is only available through Prepayment Meter vouchers. Click here for information about help available for billed users (opens in new window).

Title

First Name

Last Name

Date of Birth

Address

Address Line 1

Address Line 2

City

Post Code

Energy details

Select what you have

Electricity and Gas (same supplier)

Electricity and Gas (different suppliers)

Electricity only

Energy Supplier

Energy Supplier – Electricity

Energy Supplier – Gas

Where can you top up?

PayPoint

Post Office

How would you like to receive the energy voucher? (If you don’t have access to either you can put a friend/relative’s down)

By text message

By Email

Confirm Email

Mobile phone

Confirm Mobile phone

PLEASE NOTE: Keep an eye out on your junk mail box. Please try and use the vouchers within 5 days of receiving them.

PLEASE NOTE: Keep an eye out for text messages. Keep an eye out on your junk mail box. Please try and use the vouchers within 5 days of receiving them

Do you have a smart meter?

Yes

Unknown

Brief description of your circumstances – why you are struggling to top up.

Are you sure you are claiming all the benefits you are entitled to?

Yes

We will send you a link to complete a benefit check. Or you can click here to complete one now: https://securesupport.org.uk/benefit-check/ (opens in new window)

Household details

How many of these adults are 66+

You may be eligible for one of the following through a grant fund. If you need any of the below, please pick one.

I DO NOT NEED HELP WITH THESE

Baby equipment (including pushchairs)

Children’s beds (including cots, single beds, bunk beds)

Clothing in an emergency

Furniture items (including soft furnishings)

Kitchen equipment and small appliances

White Goods (cooker, washing machine, tumble dryer or fridge freezer)

How do you want us to send you the link?

E-mail

Text message

Whatsapp message

Just show me the link now instead

https://securesupport.org.uk/white-goods/ (opens in a new window)

We will email you a link – please check your junk mailbox

Evidence

Photo proof of name and address (letter, drivers licence etc)

Choose File

Photo of balance on meter (criteria: will run out within 48 hours)

Choose File

I confirm that I cannot afford to top up my energy meter and it has either ran out, or will run out within 48 hours.

I give permission for my details to be passed to our energy topup partners for the purpose of providing an energy topup voucher.

I give permission to receive a text or email from you or your energy support partners with information about additional support or offerings.

I agree that my information can be kept for 2 years which will help with auditing and any future requests I make for support.