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1
Full Name* This field is required.
First Name
Last Name
2
Address* This field is required.
Street Address
Street Address Line 2
City
Postal Code
Please Select
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3
Phone Number* This field is required.
Area Code
Phone Number
4
Email* This field is required.
example@example.com
5
Which of the following describes your circumstances?
I own my own home
I rent my home from a private landlord
I rent my home from the council or housing association
I am the landlord
6
How many floors does your property have?
7
When was your home built?
Before 1900
1900 - 1929
1930 - 1949
1950 - 1966
1967 - 1975
1976 - 1982
1983 - 1990
1991 - 1995
1996 - 2002
2003 - 2006
2007 - 2011
2011 - Later
8
What Type of Roof Insulation?
I don't know
Pitched Roof - No Insulation
Pitched Roof - Insulated
Flat Roof - No Insulation
Flat Roof - Insulated
9
What Type of Wall Insulation?
I don't know
Cavity Wall - No Insulation
Cavity Wall - Insulated
Solid Wall - No Insulation
Solid Wall - Insulated
10
What sort of glazing?
I don't know
Single Glazing
Double Glazing
Triple Glazing
11
What Kind of Floor Do You Have?
I Don't Know
Solid Floor
Suspended Timber Floor
None
12
Which Type of Fuel Supplies Your Heating?Enter the main type of fuel that your heating system uses – the majority of properties use gas central heating.
Electricity
Mains Gas
LPG Gas
Heating Oil
Solid Fuel
I Don't Know
13
Do You Have a Hot Water Cylinder?If you have a combi boiler, you won’t have a hot water cylinder
YESNO
14
Do You Have a Gas Boiler?If you are not sure whether your boiler is condensing then look at the boiler unit – a condensing boiler will have a white plastic pipe coming from the bottom in addition to any metal gas/oil pipes.
YESNO
15
How Old is Your Gas Boiler?
16
Are You Currently Receiving A Form Of Benefit?If you click yes, we’ll use this information to calculate which grants you might be eligible for, and ask you a few questions about your benefits status
YESNO
17
We Install Energy Efficiency Measures To Homes Across the UK. Which Of These Are You Interested In?
Internal Wall Insulation
Room In Roof Insulation
Loft Insulation
Boiler Replacement
Suspended Floor Insulation
Windows (Single Glazed Replacement Only)
External Doors (Single Glazed or Solid Door Replacement)
Should be Empty: