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Copy of Free Grants

Your Data Is Stictly Confidential And Will Only Be Used For The Sole Purpose Of Obtaining Government Funded Grants – We Do Not Sell On To Other Parties.

Free Heat Pumps / Free Solar - Survey

Step 1 of 14

7%

How Is Your Home Heated?*
- Oil Boiler
- Lpg Boiler
- Electric Storage Heaters
- Gas Back Boiler Behind The Fire
- Solid Fuel
- Gas Boiler
- Warm Air System
- Gas Room Heaters

Please Confirm You Are Happy To Be Contacted By An Approved Installer*
- I Am Happy To Be Contacted
No Time Wasters Please You Will Only Be Contacted If We Feel You May Be Eligible For A Grant

Which Benefit Do You Receive?*
- Universal Credit
- Pension Credit
- Tax Credits
- Job Seekers / Income Support
- Child Benefit
- Employment & Support Allowance -Income Related
- Housing Benefit
- No Benefits - Low Income Household

Which Grant Are You Interested In ?*
- Heat Pump & Solar
- Free Heat Pump
- Free Solar

Do You Own The Property ?*
- I Am The Home Owner
- I Live With The Home Owner
- Private Rented
- I am The Landlord
- Council / Housing Association -NOT ELIGIBLE

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

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

How Old Is Your heating?*
- Under 10 Yrs Old
- 10 -17 Yrs Old
- Over 18 Yrs Old

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

Please Enter Your Postcode*
House Number & Ist Line Of Address*

Applicants Full Name*
Applicants Date Of Birth*

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

Best Time To Phone You To Book Your Free Survey*
- Any Time
- Morning
- Afternoon
- Early Evening
GENUINE APPLICANTS ONLY PLEASE Please do not submit this form if you never answer your phone.

Please Provide A Password - ( Fave Pet Or Fave Group. etc )*
SECURITY PASSWORD To ensure you are only contacted by our approved installers , Please request the password from the installer when they call

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