FreeBoilerGrantsUK

Name *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Date of Birth *

Date of Birth

Email Address *

Phone *

Confirm Occupancy *

Home OwnerPrivate TenantLandlordCouncil TenantWhat is your relationship to the property you are applying for?

Household Income

House Hold Health

List of Health Conditions

Other Benefits

What is the properties EPC rating

What is your Property Type

What year was your property built

Are your walls insulated?

External Wall Type? *

Confirm your Boiler Details *

Is the Property Listed?

Confirm Prior Works to the property *

Solar PanelsLoft/Roof Insulation (Any)Wall Insulation (Any)Floor Insulation (Any)New Boiler / Central Heating (Any)No Works in last 8 yearsThermalYou must select one or some of the options (if fitted to the property in the last 8 years)

Has this property had ECO Funding before?

YesNoUnknown

Approximate Date of Funding

Free Measure Options (Select what you would like fitted to your Property) *

New Condensing Gas BoilerNew Storage HeatersAir Source Heat PumpLoft InsulationInternal Wall InsulationExternal Wall InsulationFlat Roof InsulationSolar PanelsPlease not that not all measures are suitable and this would be discussed when we complete a free survey.

Additional Property Information

Solid Ground FloorFloor BoardsBasementLoft Insulation (More than 100mm)Loft Insulation (Less than 100mm)No Loft InsulationWater Tank on Boiler?Please select if you have any of the following

Consent and Submit *

I agree to my information provided being shared with the Department for Work and Pensions via the Energy Saving Trust to confirm whether I am in receipt of the relevant benefit(s) to be eligible for the ECO4 and GBIS schemes. I authorise freeboilergrants uk to contact me in relation to funded home improvements from other companies.Please Tick the 2 tick boxes then add your signature below

Signature *

Upload Photo of boiler/heating source if possible

No file chosen

Please upload a photo of boiler/heating if possible