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Register Your Interest
To register your interest,
please fill out the form below.
FIRST NAME *
LAST NAME *
EMAIL *
PHONE *
SELECT AN ADDRESS *
WHAT IS YOUR CURRENT TENURE? (PLEASE NOTE, WE MAY NOT BE ABLE TO ASSIST IF YOU LIVE IN SOCIAL HOUSING) *
Homeowner
Privately rented
Social housing rented
What is your EPC? *
Select...
EPC 1
EPC 1
Does the property have a gas con*
Select...
Yes
No
MAIN HEATING SYSTEM *
GAS CENTRAL HEATING
LPG / OIL CENTRAL HEATING
ELECTRIC HEATING
OTHER
DO YOU HAVE A BOILER? *
YES
NO
HOW OLD IS YOUR BOILER *
Select...
0-2 Years
3-5 Years
6-10 Years
10+ Years
WHAT IS YOUR PROPERTY TYPE? *
DETACHED
SEMI-DETACHED
MID TERRACE
MAISONETTE
BUNGALOW
FLAT
WHAT IS THE WALL TYPE? *
SOLID BRICK
STONE
CAVITY WALL
UNSURE / OTHER
CURRENT HEATING SYSTEM? *
ELECTRIC STORAGE HEATERS
GAS CENTRAL HEATING FROM
GAS FIRE / BACK BOILER
SOLID FOSSIL FUEL FIRE / OPEN FIRE
OIL HEATERS
NO HEATING IN PLACE
WOOD/ BIOMASS HEATING
OTHER
BENEFITS BEING CLAIMED AT PROPERTY? (PLEASE NOTE, WE MAY NOT BE ABLE TO ASSIST IF YOU ARE NOT CLAIMING BENEFITS) *
CHILD TAX CREDITS (CTC)
CHILD BENEFITS
JOBSEEKERS ALLOWANCE (JSA)
EMPLOYMENT & SUPPORT ALLOWANCE (ESA)
INCOME SUPPORT (IS)
PENSION CREDIT GUARANTEE CREDIT
WORKING TAX CREDIT (WTC)
PENSION CREDIT SAVING CREDIT
NOT CLAIMING BENEFITS
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