This form MUST be completed fully by the referral agent and NOT by the client. The referral agent must provide two telephone contact numbers for the client at the time of completing the referral request (it is not acceptable for the Referral agent to be the second contact number other than in exceptional circumstances)
Please note: Roundabout is no longer providing furniture via referrals to persons resident within the Worcester City boundary.
Furniture referrals for Worcester City residents should now be made to Armchair 01905 456080
Please read the Referral Terms before filling in the form. You will be required to agree to these terms before the information can be submitted.
Should you require an item not on the list then please contact the office before submitting the form and enter the details discussed in the ‘Other Information’ box below.
Please fill in the details in the boxes or select, as required. An asterisk denotes a required field. When completed, please click the send button. If there are any omitted required fields, you will be prompted to fill them in before clicking the send button again. Once successful, a confirmation will display on screen and an email will be sent to the Roundabout office.
Please ensure all details are entered correctly.
Covid-19 Government guidelines may result in the clients furniture only being delivered to the roadside door of the clients address.
The Referral Form has been updated, as of May 2019, to include a mandatory alternative contact number. This is to minimise the risk of non-delivery due to the primary contact numbers not being answered. A referral request will not be processed unless an alternative contact number is provided which should not be the referral agent (unless there are exceptional circumstances)