Survey For Free Central Heating - Warm Front UK

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Free Central Heating Survey

Short Survey To See If You Are Eligible

Your Data Is Stictly Confidential And Will Only Be Used For The Sole Purpose Of Obtaining Government Funded Grants – We Do Not Sell On To Other Parties.

GENUINE ENQUIRIES ONLY

PLEASE DO NOT FILL IN THE FORM IF YOU DO NOT ANSWER YOUR PHONE. THANK YOU

Survey - Free Central Heating

Step 1 of 13

7%

Have You Had Central Heating Fitted In The Past ?*
- Never Had Central Heating Fitted.
- Old Central Heating Is Fitted

Which Benefit Do You Receive?*
- Universal Credit
- No Benefits- I Am On A Low Income
- Tax Credits
- Pension Credit Guarantee
- Job Seekers Allowance
- Income Support
- Employment & Support Allowance
- Child benefit

Is There A Gas Supply To Your Home?*
- Yes- Gas Supply To My Home
- No Gas Supply To My Home
- Unsure
Do You Have A Gas Meter Fitted To Your Property ?*
- Gas Meter Is Fitted
- No Meter Fitted

Do You Have Radiators Fitted?*
- Yes- Radiators Are Fitted
- No Radiators Fitted

What Is Your Current Heating*
- Electric Storage / Room Heaters
- Gas Boiler & Radiators
- Solid Fuel / Coal Fire
- Warm Air System
- Gas Fire & Backboiler
- Gas /Oil Room Heaters
- Bottled LPG Heating

Which Insulation Is Required*
- Free Insulation Package -For Whole House
- Free Loft Insulation
- Free Cavity Wall Insulation
- Free Solid Wall Insulation
- My Home Is Fully Insulated

What Is Your Housing Status?*
- Home Owner
- Landlord
- Private Tenant
- Council /Housing Association Tenant

What Is Your Property Type*
- Mid / Ground Floor Flat
- Top Floor Flat With Loft
- Semi Detached House
- Detached House
- Semi Bungalow
- Detached Bungalow
- Terraced House
- Park Home

How Many Bedrooms Do You Have*
- One Bedroom
- 2 Bedrooms
- 3 Bedrooms
- 4 Bedrooms +

Ist Line Of Address*
Please Enter Your Postcode*

Your Full Name*
Your Date Of Birth*

Your Phone Number*
Your Email Address OR 2nd Phone Number*

Best Time To Call You*

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