ECO Form (Internal)

Property Ownership Status *

Social Housing Homeowner Private Rented

Rural (Check Ofgem Site) *

Yes No

Does anyone in your household receive a state benefit? Select all that apply.

No Benefits Universal Credit Income Based Job Seekers Allowance Income Related Employment and Support Allowance Income Support Housing Benefit Child Benefit Pensions Savings Credit Pension Credit Guatantee Tax Credits (Child or Working Tax Credit)

What is your main heating type? *

Mains Gas Oil LPG Electric Boiler Storage Heaters Electric Room Heater Multifuel Other

Is your boiler condensing or non condensing? Does it have a white plastic pipe coming from below the boiler? *

Condensing - Yes white plastic pipe Non-Condensing - No white plastic pipe Don't know Not Applicable

Underfloor Heating *

Yes No

Heating Controls *

None Thermostat Programmer TRVs Zonal

Hot Water Tank *

Yes No

Insulation

Foam Jacket

What is the current EPC band for the property? Check post code and address on the Scottish EPC register *

E F G No EPC

What is the total floor area of the property? Check EPC data *

0-72 73-97 98-199 200+ No EPC

Extensions

Yes No

Room-in- Roof

Yes No

Wall Insulation Present?

Yes No

Loft Insulation Present?

Yes No

If Room in Roof - is this insulated

Yes No

Floor Insulation

Yes No

Open Fireplaces

Yes No

How did you hear about us?

Flyer Recommendation Internet search engine (eg. Google) TV Radio Social media (eg. Facebook) Referral Reward Shelter Scotland Other

We will never share your details with third parties without your permission. By submitting this application you consent to the processing of your personal data in accordance with our Privacy Policy which can be viewed online at: www.greenhomesystems.co.uk/privacy-policy *

I agree with the Privacy Policy