Your details

Title:
—Please choose an option—MrMrsMsMissDrOther

Your name:

Date of Birth: (example) 12/11/1991

Your email

Telephone number

Your address

What time is best to call?

—Please choose an option—Any time9am - 10am10am - 11am11am - 12pm12pm - 1pm1pm - 2pm2pm - 3pm3pm - 4pm4pm - 5pm

Housing status

Do you own your own home?

YesNo

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Benefits Received

Please select one of the benefits you are in receipt of then submit the form.

* This field is required You only need to be in receipt of one of the qualifying benefits to access the funding.

—Please choose an option—Tax credits; Child and Working Tax CreditsChild BenefitPersonal Independence Payment AllowanceDisability Living AllowanceCarer’s AllowanceIncome SupportUniversal CreditAttendance AllowanceIndustrial injuries disablement AllowanceSevere disablement AllowanceIncome-related employment and support allowanceIncome-Based Job Seeker’s AllowanceState Pension Credit (In receipt of Pension Credit Guarantee Credit or both Guarantee Credit and Savings CreditWar Pensions Mobility SupplementArmed Forces Independence PaymentConstant Attendance AllowanceNone apply

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Property Information

Please choose your property type from the drop-down list

—Please choose an option—Bungalow - DetachedBungalow - End TerraceBungalow - Mid TerraceBungalow - Semi DetachedEnd-TerraceMid-TerraceSemi-DetachedDetachedFlat (with 2 External Walls)Flat (with 3 External Walls)Maisonette (with 2 External Walls)Maisonette (with 3 External Walls)

Select the number of bedrooms in your property

—Please choose an option—123456 or more

Do you have a room in your loft ?

—Please choose an option—YesNo

What is the approximate age in years of the property?

Select heating type

—Please choose an option—GasElectricLPGOilSolid Fuel

Who is your current Electrical supplier?

—Please choose an option—British GasEDFeonnpowerScottish PowerSSEOther

Who is your current Gas supplier?

—Please choose an option—British GasEDFeonnpowerScottish PowerSSEOther

Select Your boiler issues:

—Please choose an option—No Heat or Hot WaterLeaking and DrippingKettlingPilot Light Goes OutLow Boiler PressureFrozen Condensate PipeThermostat IssuesStrange Banging, Whistling or Gurgling NoisesRadiators Not Heating UpBoiler Keeps Switching Itself OffOther

Does your property have Loft insulation?

—Please choose an option—YesNoDon't know

Does your property have Cavity Wall insulation?

—Please choose an option—YesNoDon't know

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Unfortunately, under the ECO3 scheme you must be a homeowner to qualify. However, you may be able to arrange for the installation of energy efficiency measures with your landlord/homeowner who can apply for those measures under the Green Homes Grant Scheme.

Please click on 'Submit form' and we will be in touch

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