Enquiry Form Leave this field blank First name Last name Telephone Number Email address Address Postcode Your Local Authority Items of interest Cavity Wall Insulation Loft Insulation Solid Wall Insulation Room in Roof Insulation High Heat Retention Electric Storage Heaters Air Source Heat Pump Solar Panels Removal of Cavity Wall Insulation I am a (council/housing association tenants do not qualify) Homeowner Private Tenant The property is a Par Home Flat Maisonette Terraced House End of Terraced House Semi Detached House Detached House Terraced Bungalow End of Terraced Bungalow Semi Detached Bungalow Detached Bungalow How many bedrooms 1 2 3 4 5+ Main Form of Heating Mains Gas Boiler Electric Room Heaters Oil Boiler LPG Boiler (Tank) Coal Boiler (Parkray, Rayburn) Coal Fires Electric Storage Heaters Electric Panel Heaters LPG Boiler (Bottles) Electric Boiler Air Source Heat Pump How old is the boiler? How many adults live at the property? How many children under 18 live at the property? Does any one living at the property receive any Government benefits? If so, please state the type of benefit. What is the total annual GROSS household income (before stoppages). Could be a qualification for LA Flex application Less than £20,000 £20,001-£30,000 £30,001 - £40,000 £40,001 - £50,000 £50,000+ Does anyone living at the property suffer from any medical conditions? If so, please state which. This could be a qualification for LA Flex application. Additional Notes (optional) Submit