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FREE STORAGE HEATER APPLICATION FORM

Your Data Will Only Be Used For The Sole Purpose Of Obtaining Government Grants – We Do Not Sell On To Other Parties.

Survey - Grants For Storage Heaters

Step 1 of 13

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Which Grant Are You Interested In? (Tick All That Apply )*
- Free Central Heating
- Free Air Source Heat Pump
- New Storage Heaters
- Free Solar
Some Homes Will Be Eligible For FREE HEAT PUMPS / FREE CENTRAL HEATING / Free Solar

Which Benefit Do You Receive?*
- Universal Credit
- Pension Credit Guarantee
- No Benefits - I Am On A Low Income
- Tax Credits
- Job Seekers / Income Support
- Employment & Support Allowance
- Child Benefit
- Housing Benefit

What Is Your Housing Status?*
- Home Owner
- Landlord
- Private Tenant
- Council / Housing Association Tenant
- Shared Ownership

What Is Your Property Type*
- Terraced House
- Semi Detached House
- Detached House
- Semi Detached Bungalow
- Detached Bungalow
- Top Floor Flat With Loft
- Mid / Ground Floor Flat
- Park Home

How Many Bedrooms Do You Have*
- One Bedroom
- 2 Bedrooms
- 3 Bedrooms
- 4 Bedrooms +

What Is Your Main Home Heating*
- Electric Storage Heaters
- Gas Boiler & Radiators
- Gas Back Boiler
- LPG Heating
- Oil Heating
- Warm Air System
- Solid Fuel / Coal Fire
- No Heating System Present

Which FREE Insulation Do You Require*
- Whole House Check Required.
- Loft Insulation
- Cavity Wall Insulation
- Room In Roof Insulation
- Internal / External Wall Insulation
- My Home Already Fully Insulated

Do You Have a Gas Meter Fitted ?*
- Meter Is Fitted
- No Meter Is Fitted
- Unsure

Please Enter Your Postcode*
Ist Line Of Address*

Applicants Full Name*
Applicants Date Of Birth*

Your Phone Number*
2nd Phone Number OR Email Address*

Please Provide A Password*
Please provide us with a password to assist you properly Favourite Pet Or Favourite Group. Thank you.

Best Time To Phone You To Book Your Free Survey*
- Morning
- Afternoon
- Early Evening
- Any Time
GENUINE APPLICANTS ONLY PLEASE Please do not submit this form if you never answer your phone.

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