Personal details First name Last name Address line 1 Address line 2 City Postcode Phone number Email address Current rent status Have you received a letter from us about your rent payments? Yes No Please confirm the reference number on your letter L1 L2 L3 L4 L4B NSPA Would you like to propose a repayment arrangement? Yes No If you are unable to make a payment, please provide details of why you are unable to make a payment/repayment plan. Please provide details of what support you need to make payments. When you would like to make your first payment? When you would like to make your first payment? How often you would like to pay? Weekly (every 7 days) Fortnightly (every 14 days) Four Weekly (every 28 days) Monthly (the same day every month) How much would you like to pay in addition to your rent? Please provide details of any support you may need to make the repayments. Privacy Our privacy statements tell you what data we collect, how we use it, how long we keep it and when we may share it. To find out more please see our privacy statements. I confirm that I have read and understood the Sanctuary privacy statements Leave this field blank