Capture Form What's your relation to your home? Homeowner Renting Via Agent Renting Via landlord Living With Homeowner Council Tenant Social Tenant Landlord / Agent Are you currently receiving any benefits or tax credits? * Yes No Note* You dont have to be receiving benefits to qualify. Do any of the below apply to your current situation? Household income is below £31,000 I received the Council Tax Rebate Someone suffers from a cardiovascular (Heart) Condition Someone suffers from a respiratory conditon (Such as COPD, Asthma Or Lung Disease) Someone suffers from limited mobility (Has arthritis or receives PIP or DLA) Someone who is Immunosuppressive (Suffers from Diabetes, or is taking medicines that weaken the immune system) Someone in the property has a mental health condition None of the above Note* You dont have to be receiving benefits to qualify. Select one benefit that applies Child Benefit (Income thresholds apply) Working Tax Credit Pension Saving Credit Pension Guaranteed Credit Housing Benefit Income Support Job Seekers Allowance Employment Support Allowance None of the above Note* You dont have to be receiving benefits to qualify. What is the main heating source in your home? Main Gas Boiler Electric Room Heater Electric Storage Heater Gas Room Heater Electric Boiler LPG Boiler (Bottled) LPG Boiler (Tanked) Oil Boiler Solid Fuel Boiler Wood / Coal Air Source Heat Pump Gas Warm Air Boiler Underfloor Heating Hybrid System No Mains Heating Not Sure! What type of walls does your property have? Solid Wall Cavity Wall Timber Framed System Built Other Unsure If you're unsure, please click on the link below to be taken to the Energy Performance Register, where you easily find your property EPC and confirm your wall type in the "Features" section. Click Here To Find Your Wall Type. [Click Here To Find Your Wall Type.](https://www.gov.uk/find-energy-certificate/). Do you know if your walls are insulated? Yes (Insulated) No (Not Insulated) Unsure If you're unsure, please click on the link below to be taken to the Energy Performance Register, where you find your property EPC, and confirm if your wall are insulated in the "Features" section. [Click Here To Find Your Wall Type. ](https://www.gov.uk/find-energy-certificate/). What type of roof does your property have? Conventional Loft (with hatch) Flat Roof Room-In-Roof Other Dwelling Above If you're unsure, please click on the link below to be taken to the Energy Performance Register, where you find your property EPC, and confirm if your wall are insulated in the "Features" section. Click Here To Find Your Wall Type. [markdown](https://www.gov.uk/find-energy-certificate/). Has your loft insulation been topped up since 2017? Yes (Topped Up) No Unsure If you're unsure, please click on the link below to be taken to the Energy Performance Register, where you find your property EPC, and confirm if your wall are insulated in the "Features" section. Click Here To Find Your Wall Type. [markdown](https://www.gov.uk/find-energy-certificate/). What type of property do you live in? Detached House Semi-Detached House Mid-Terraced House End-Terraced House Bungalow Chalet Bungalow Ground Floor or Mid Floor Flat Top Floor Flat Ground Floor or Mid Floor Maisonette Top Floor Maisonette 🎉 GREAT NEWS! 🎉 You are eligible for the government's ECO4 scheme and up to £50,000.00 in FREE energy-saving improvements! Please provide your details below, and we will be in touch in the next few days! Your Name * Email * Phone * Address Address Address Address City City County County PostCode PostCode If you are human, leave this field blank. ContinueSubmit Use Shift+Tab to go back
