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If You Are Deemed Eligible, Our Approved Agents Will Be In Touch In The Next Few Days.
Please ensure you are contactable by phone.
In accordance With Our Privacy Policy - Your Data Is Stictly Confidential And Will Only Be Used For The Sole Purpose Of Obtaining Government Funded Grants - We Will Not Sell On To Other Parties.
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Survey - Free Central Heating
Step 1 of 13
7%
Please Confirm You Do Not Have Central Heating Fitted
*
I Do Not Have Existing Central Heating Fitted.
Which Benefit Do You Receive?
*
DLA / PIP
Universal Credit
Pension Credit Guarantee
Attendance Allowance
Carers Allowance
Tax Credits - Child & Working
Job Seekers / E S A
Income Support
Industrial Injuries Benefit
NO BENEFITS ? - DO NOT APPLY
Child Benefit
DO NOT APPLY IF NO BENEFITS PLEASE
What Is Your Housing Status?
*
Home Owner
Private Tenant
Landlord
Council Tenant - NOT ELIGIBLE
Shared Ownership
Housing Asscociation
What Is Your Property Type*
*
Top Floor Flat
Ground / Mid Floor Flat
Terraced House
Semi Detached House
Detached House
Semi Detached Bungalow
Detached Bungalow
Park Home
How Many Bedrooms Do You Have ?
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1 Bedroom
2 Bedrooms
3 Bedrooms
4+ Bedrooms
How Is Your Home Heated ?
*
Electric Storage Heaters
Gas Boiler & Radiators
Solid Fuel / Open Fire
Warm Air System
Backboiler & Gas Fire
LPG / OIL Boiler
No Heating System Present
When Was Your Loft Last Insulated ?
*
Over 5 Years Ago
Over 10 Years Ago
Unsure - Free Check Please
Recently Insulated
Do You Have A Gas Meter Fitted
*
A Gas Meter Is Fitted
NO GAS METER FITTED
Your Full Name
*
Your Date Of Birth
*
Please Enter Your Postcode
*
Ist Line Of Address
*
Phone Number
*
2nd Phone Number or Email Address
*
How Would You Like To Be Contacted?
*
Phone Call
Email
Text
Best Time Of The Day To Call You
*
Any Time
Morning
Afternoon
Early Evening
If Tenant -Provide Landlord Name & Number
Landlord Permission Is Required For All Rental Properties
Name
This field is for validation purposes and should be left unchanged.
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