ECO4 Enquiry Form Leave this field blank First Name Surname My telephone number is My Email address is My Address is Town/City Postcode My Council/Local Authority is Items of Interest Cavity Wall Insulation Loft Insulation External Wall Insulation 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 This is "paid for". There are no grants. EPC I am a Council and Housing Association tenants do not qualify Home Owner Private Tenant The property is A Park Home A Flat A Maisonette A Terraced House An End of Terraced House A Semi-Detached House A Detached House A Terraced Bungalow An End of Terraced Bungalow A Semi-Detached Bungalow A Detached Bungalow How many bedrooms? 1 2 3 4 5+ My main form of heating is Mains Gas Boiler Gas Room Heaters Oil Boiler Coal Boiler (e.g. Parkray, Rayburn) LPG Boiler (Bottles) LPG Boiler (Tank) Coal Fires Electric Storage Heaters Electric Panel Heaters Electric Boiler Air Source Heat Pump If your heating is generated using a Boiler (Mains Gas. Oil or LPG) 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? Total Household Gross Income (before stoppages) 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. Additional Notes (optional) (optional) Send Accreditations
