COMPLETE THIS SIMPLE FORM TO SEE IF YOU QUALIFY TODAY
Answer a few questions to check your grant eligibility.
Name:
*
First Name
Last Name
E-mail
*
Phone Number
*
House Number
*
Street Name
*
Postcode
*
Has your property ever had gas central heating before?
*
YES
NO
Do you or anyone in the property claim a benefit? (Qualifying benefits listed below)
*
YES
NO
How is your house currently heated?
*
Electric Room Heaters
Electric Storage Heaters
Gas Room Heaters
Single Gas Fire
No Heaters
Gas Warm Air System
Electric Warm Air System
Boiler & Radiators
Back Boiler Radiators
Oil Boiler Radiators
Solid Fuel Boiler and Radiators
Is your house rented or owned?
*
Owned
Rented
What is your house type?
*
Terraced
Semi-detached
Detached
Bungalow
Flat
Other
How many bedrooms does your house have?
*
1
2
3
4
5
6+
Any other comments:
(Optional)
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Should be Empty: