1. Full Name *

2. Address (1st Line) *

3. Postcode *

4. Telephone Number *

5. Email *

6. Are you the homeowner? *
TenantLandlordHomeowner (occupant)Other

7. Does your household meet any of the following criteria? *
Receive benefitsEarn under £31,000 annuallyHave a medical conditionNone of the above

8. How much loft insulation does your property have? *
NoneLittle (1mm - 100mm)Moderate (101mm - 200mm)Lots (201+ mm)Unknown

9. What fuel is used to heat the property? *
Mains gasElectricOilLPGBiomassSolid fuel (coal, wood, etc.)UnknownOther

10. How old is your heating system? *
Recent upgrade (0-5 years)Moderately old (6-15 years)Aging system (20+ years)Unknown

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