Survey Request

Full Name*
Email*
Phone number*
Street Address Line 1*
Street Address Line 2
City*
County / State / Region*
Postcode*
What services are you Interested on?

LEAP Assessment (Free)EPC (Energy Performance Certificate)Retrofit AssessmentRetrofit CoordinatorTechnical MonitoringOther
What is your current living arrangements?

Home OwnerPrivate RentingSocial HousingHousing Association
Are you eligible for LEAP?

YesNoNot Sure
LEAP Eligibility

In receipt of a benefitHousehold income under £31,000
Please select from the above which option you believe fits your eligibility. You can select more than one.
Interested in

LEAP Home VisitAppliances/White GoodsGas Boilers Repair/Replacement
You can select more than one of the above options.
Best appointment time

AMPM
Our appointments are Monday to Friday. A convenient time will be discussed with you, but this gives us an idea as to what times to offer to you, when we reply to your equiry.
How would you like us to contact you?

Please emailPlease call
Any additional comments?
How did you hear about Smart NRG?

GoogleFacebookInstagramTwitterLocal MagazineRadioLocal councilCitizens AdviceOther Charity / Community SupportWord of Mouth
This helps us to understand where we can reach people that require our support the most.
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Please subscribe me to receiving low frequency, newsletters with regards to funding and energy tips to help reduce my energy bills. I understand that I can unsubscribe at any time.I do not wish to receive any newsletter communication.
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