Title: —MrMrsMsMissDrOther
Your name:
Date of Birth: (example) 12/11/1991
Your email
Telephone number
Your address
What time is best to call?
—Any time9am – 10am10am – 11am11am – 12pm12pm – 1pm1pm – 2pm2pm – 3pm3pm – 4pm4pm – 5pm
Do you own your own home?
YesNo
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.
—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
Please choose your property type from the drop-down list
—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
—123456 or more
Do you have a room in your loft ?
—YesNo
What is the approximate age in years of the property?
Select heating type
—GasElectricLPGOilSolid Fuel
Who is your current Electrical supplier?
—British GasEDFeonnpowerScottish PowerSSEOther
Who is your current Gas supplier?
Select Your boiler issues:
—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?
—YesNoDon't know
Does your property have Cavity Wall insulation?
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
