Enquiry Form Enquiry Form Leave this field blank First Name Surname Address Post Code Telephone Number Email Address I am a Home Owner Private Tenant Housing Association Tenant Item of Choice (only choose 1) Cavity Wall Insulation Loft Insulation External Wall Insulation Internal Wall Insulation Pitched Roof Insulation Flat Roof Insulation Room in Roof Insulation Park Home Insulation The property is State Mid Terrace House End of Terrace House Semi Detached House Detached House Mid Terrace Bungalow End of Terrace Bungalow Semi Detached Bungalow Detached Bungalow Flat Maisonette Park Home How many bedrooms? The main heating is State Mains Gas Boiler Gas Room Heaters Oil Boiler Coal Boiler (e.g. Parkray, Rayburn) LPG Boiler with Tank LPG Boiler with Bottles Coal Fires Electric Storage Heaters Electric Panel Heaters Electric Boiler Air Source Heat Pump How many adults live at the property? How many children under the age of 18 live at the property? What is the total household income (before stoppages) State Less than £31,000 £31,001 - £40,000 £40,001 - £50,000 £50,001 - £60,000 More than £60,001 Does anyone living at the property receive Government Benefits? If so, please list then. Does anyone living at the property suffer from a medical condition? If so, please state which. Send