This form has a maximum of 4 pages
If you wish to rent the Lifeline unit via mail order there is no upfront cost. Simply fill in the details on this form and we will send your Lifeline unit and welcome pack out to you.
In order to have the Lifeline installed you must have a landline telephone connection in the property.
Complete the direct debit instruction form in your welcome pack and return this to us.
Warwick District Council holds certain information about you (personal data) which we need to manage your Lifeline Service.