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Eco Grant Form
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Step
1
of 9
Q1. Which option applies to the property in question?
Home Owner
Private Tenant
Local Authority / Housing Association
Landlord
Other
Next
Q2. Which of these best describes your home?
Semi-detached
Detached
Terraced
Bungalow
Flat
Next
to contact you
Q3. How many bedrooms are in your home?
1
2
3
4
5+
Next
Q4. Current Heating Type>
Before 1900
1900 - 1925
1925 - 1980
1980 - 2000
2000+
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Q5. Does a member of your household claim any of the following benefits? (select all that apply) *
Mains Gas
Oil Boiler
LPG
Electric Storage Heaters
Electric Room Heaters
Solid Fuel Boiler
Biomass
Heat Pump
Other
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Q6. Property age
Working Tax Credits
Child Tax Credits
Income Support
Universal Credit
Income Based JSA
Income Based ESA
Housing Benefit
Pensions Savings Credit
Pension Guarantee Credit
None Of The Above
Next
Q7. What type of home improvement grant interests you? (All measures are free of charge)
Loft insulation
Internal wall insulation
Cavity wall Insulation
Room in Roof insulation
Suspended floor insulation
Air Source Heat Pump
Solar Panels
Heating Controls
Next
Q8. Your Address
House Number / Name
Postcode
Next
Q8. Your Contact Details
Name
Phone
Email
*
Best time to contact you
9am - 12pm
12pm - 5pm
5pm - 8pm
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