Enquiry Form Leave this field blank First name Last name Email address My telephone number My address is Town Postcode My Council/Local Authority Items of Interest Cavity Wall Insulation Loft Insulation External Wall Insulation Internal Wall Insulation Room in Roof Insulation Gas Central Heating System High Heat Retention Electric Storage Heaters Air Source Heat Pump Solar Panels Removal of Cavity Wall Insulation (no grant available) I am a Home Owner Private Tenant Council and Housing Association tenants do not qualify My property is a Park Home Flat Maisonette Terraced House End of Terrace House Semi-Detached House Detached House Terraced Bungalow End of Terrace Bungalow Semi-Detached Bungalow Detached Bungalow How many bedrooms? 1 2 3 4 5+ My main heating is Mains Gas Boiler Gas Room Heaters (Fires) Oil Boiler Coal Boiler (e.g. Parkray or Rayburn) LPG Boiler (Tank) 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 anyone living at the property receive benefits? If so, which benefits? Total Gross Household Income (before stoppages)? Could be a qualification for L A Flex No more than £20,000 pa £20,001 - £31,000 £31,001 - £40,000 £40,001 - £50,000 £50,001+ Does anyone living at the property have any medical conditions? Could be a qualification for L A Flex Additional Notes. (optional) (optional) Send Accreditations
