COMPLETE THIS SIMPLE FORM TO SEE IF YOU QUALIFY TODAY
Answer a few questions to check your eligibility for a free heat pump installation. We’ll only contact you if you qualify.
How do you heat your home ?
*
OIL
LPG
OTHER
Does your system have a hot water tank?
*
YES
NO
Do you have cavity walls?
*
YES
NO
Is your loft insulated?
*
YES
NO
Don't Know
If ‘Other’, please describe your heating system.
House number or name:
*
Street Name:
*
Postcode
*
Name:
*
First Name
Last Name
E-mail
*
Phone Number
*
Street Name
*
What type of benefit do you receive?
*
Income Based Jobseekers Allowance
Income related Employment & Support Allowance
Income Support
Pension Credit Guarantee
Pension Credit Savings
None
Housing Benefit
Working Tax Credit
Child Tax Credit
Universal Credit
Earning based child benefit
If you do not claim benefits, do any of these apply?
*
1) Total household earnings under 31K gross
2) Health condition including mobility, respiratory, cardiovascular, immunosuppressed
3) None of the above
Is your house rented or owned?
*
Owned
Private Rented
Council Rented
Social Housing Rented
Any other comments:
(Optional)
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Should be Empty: