Occupancy Status(Required)
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Home Owner
Private Rented
Other
What is your house type?(Required)
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Detached House
Semi-Detached House
Mid-Terrace House
End-Terrace House
Detached Bungalow
Semi-Detached Bungalow
Flat
Other
What is your current heating type?(Required)
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Gas
Lpg
Electric
Oil
No Heating Present
Other / I'm Not Sure
Select the benefit that you are receiving(Click all that apply) this can be anyone in your household that claims a benefit
Pension Credit Saving Guarantee
Pension Credit
Universal Credit
Income Based Jobseekers Allowance
Income related Employment & Support Allowance
Income Support
Housing Benefit
Tax Credits ( Child or Working Tax Credit)
Working Tax Credit
Child Benefit***
Route 3: any of these conditions will qualify you on their own ( must be confirmed by your GP) NHS Referrals
A cardiovascular condition
A respiratory disease
Limited mobility
Immunosupression
Not on Benefits? Or any health conditions, don't worry, there are other options available
Household income under £31,000
Property in council tax band A,B,C or D
What Measures are you Interested in? (Click all that apply)
Solar PV
Air Source Heat Pump
Internal Wall Insulation
First Time Central heating
Electric Storage Heaters & Upgrade
Cavity Wall Insulation
Room in Roof Insulation
Mains gas Boiler replacement (from non condensing)
Sloping ceiling insulation
Loft insulation
Other
*** Child benefit income threshold to qualify to receive ECO 4 funding
Name
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First Name
Last Name
Contact Number(Required)
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Email Address(Required)
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Address line 1 (Required)
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Address line 2
Town (Required)
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County
Postcode (Required)
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