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Age UK Free Central Heating

Government Grants For Home Improvement 2

Take A Short Survey Below. We Will Contact You If You Qualify

SCHEME ENDS SOON

Age UK - Free Central Heating Survey

Step 1 of 13

7%

Which Benefit Do You Receive?*
- Universal Credit
- Pension Credit Guarantee
- Housing Benefit
- Tax Credits
- Job Seekers / Income Support
- Child Benefit
- Employment & Support Allowance
- No Benefits - MIDLANDS POSTCODES ONLY

Have You Had Central Heating Fitted In The Past ?*
- We Do Not Have Central Heating Fitted.
- Central Heating Is Fitted - NOT ELIGIBLE SORRY
FIRST TIME SCHEME ONLY

What Is Your Current Main Heating*
- Old Electric Storage Heaters
- Gas Boiler & Radiators
- Warm Air System
- LPG Boiler
- Oil Boiler
- Coal Fire
- Wood Burner
- No Heating System Present

Do You Have Any Radiators Fitted?*
- No Radiators Fitted
- Radiators Are Fitted
- A Gas Boiler & Radiators Are Fitted

Which FREE Insulation Are You Interested In ?*
- I Would Like A Whole House Check
- My Home Is Fully Insulated
Insulation must be fitted to enable funding for heating upgrades.

What Is Your Housing Status?*
- Home Owner
- Landlord
- Private Tenant
- Shared Ownership
- Council Tenant -NOT ELIGIBLE
- Housing Association Tenant -NOT ELIGIBLE

What Is Your Property Type*
- Flat / Maisonnette
- Mid Terraced House
- End Terraced House
- Semi Detached Bungalow
- Semi Detached House
- Detached House
- Detached Bungalow
- Park Home

How Many Bedrooms Do You Have*
- One Bedroom
- 2 Bedrooms
- 3 Bedrooms
- 4 Bedrooms +

Do You Have a Gas Meter Fitted ?*
- We Have A Gas Meter Fitted
- No Gas Meter

Please Enter Your Postcode*
Ist Line Of Address*

Applicants Full Name*
Applicants Date Of Birth*

Your Phone Number*
2nd Phone Number OR Email Address*

Please Provide A Password
Please provide us with a password to assist you properly Favourite Pet Or Favourite Group. Thank you.
Best Time To Phone You To Book Your Free Survey*
- Any Time
- Morning
- Afternoon
- Early Evening
Please Do Not Submit This Form If You Are Not Contactable By Phone GENUINE APPLICANTS ONLY PLEASE

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