Enquiry FormBEFORE COMPLETING THIS FORM PLEASE READ THE FOLLOWING NOTES.You will not qualify for an ECO4 grant if your property has an EPC with a rating of A, B or C. Leave this field blank First Name Surname My telephone number is My Email address is My Address is Street address Town/City Postcode My Council/Local Authority is Items of Interest Cavity Wall Insulation Loft Insulation External/Internal Wall Insulation Room in Roof Insulation Gas Central Heating System High Heat Retention Electric Storage Heaters Air Source Heat Pump Solar Panels Removal of cavity wall insulation EPC I am a Council and Housing Association tenants do not qualify ChooseHome OwnerPrivate Tenant The property is ChooseA Park HomeA FlatA MaisonetteA Terraced HouseAn End of Terrace HouseA Semi Detached HouseA Detached HouseA Terraced BungalowAn End of Terrace BungalowA Semi Detached BungalowA Detached Bungalow How many bedrooms? Choose12345+ My main form of heating is ChooseMains Gas BoilerGas Room HeatersOil BoilerCoal Boiler (e.g. Parkray, Rayburn)LPG Boiler (Tank)Coal FiresElectric Storage HeatersElectric Panel HeatersLPG Boiler (Bottles)Electric BoilerAir Source Heat Pump If your heating is generated using a Boiler (Mains Gas, Oil or LPG) is it a Condensing Boiler Non Condensing Boiler I do not know Not applicable How old is the boiler (approximately)? How many adults live at the property? How many children under 18 live at the property? What is the age of oldest occupant? Does anyone living at the property receive any benefits? if so, please state type of benefit. Total Household Gross Income (before stoppages) (Could be a qualification for LA Flex applications) Less than £20,000 £20.001 to £31,000 £31,001 to £40,000 £40,001 to £50,000 £50,001 to £60,000 £60,000 plus Does anyone living at the property have any medical conditions. (If so, please state which. Could be a qualification for LA Flex applications) Additional Notes (optional) Send