Temporary referral form whilst .org.uk is being maintained - Home
 -
Referral form
Name
Address Including postcode
Up to date contact number
Referrer ie agency or self referral
do you have children
Yes
no
willing to pay delivery fee? North kirklees £7.00 South Kirklees £5.00
yes
No
are you on face book groups
yes
No
if this is a self referral a home check may be undertaken is this okay?
Yes
No
We currently do not have any carpets. We will contact you when we can help you please do not press us for a quicker response.
Items required - pleaśe note only one white good per household
Washer
Cooker - gas
Cooker - electric
Tv stand
Table and chairs
Sofa two seater
Three piece suite
Single bed
Double bed
Fridge
Fridge freezer
WArdrobe
Drawers
Side board
Coffee table
Tv _must have a TV licence

















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