Full Name*
Email*
Phone*
Address*
Address line 2
City*
Post code*
What is your tenure?* HomeownerPrivately rentingSocial housing rented
Is there a gas supply at the property?* YesNo
What is your current heating system?* Electric: Underfloor/ceiling heatingGas: Fixed mains gas heaters (not central heating from boiler)Solid fossil fuel fire/back boiler/heatersWood/biomass heatingNo heating in placeElectric: Directional, fan or storage heatersGas fire/back boilerBottled LPG heatingOil heaters
Select the Benefit You Are Receiving?* Child Tax Credits (CTC)Jobseekers Allowance (JSA)Income Support (IS)Universal Credit (UC)Working Tax Credit (WTC)Pension Credit Saving CreditChild Benefits - depends on income threshold†Employment & Support Allowance (ESA)Pension Credit Guarantee CreditWarm Home Discount Scheme RebateHousing Benefit
