How to Apply

Referring Organisation / WINZ office / or self referral

CLIENT CONTACT INFORMATION

Name of Client

First Name

Last Name

Phone

Date of Birth

Address

WORK AND INCOME CLIENT INFORMATION (please fill in if applies)

Work and Income Client Number (if you have one)

Are you on the Job Seeker Benefit?

Do you have access to TTW?

CLIENT SIZE INFORMATION

Size

Client waist size

Select waist size in inches

Shoe size

ADDITIONAL INFORMATION

Job Seeking Industry

Please select the industry:

Ethnicity

Comments

Please add any extra comments here

Privacy

The information on this form is collected for Fix Up, Look Sharp use only. I give permission for Fix Up, Look Sharp to use my before and after photos on their website and social media platforms.

Agree

Disagree

Referral Form