Name *

Phone Number *

Email *

Address (including postcode) *

Type of Home Type of Home detached Semi detached Terraced appartment/flat bungalow

number of rooms

number of bedrooms

number of bathrooms

approximate year the house was built

Type of Heating - Fuel Type of Heating - Fuel gas oil solid fuel electric

Type of Heating - Boiler Type of Heating - Boiler condensing back boiler combination boiler standard

Age of boiler

Type of Heating Output Type of Heating Output Radiators

How Many Radiators

Age of Radiators

Type of Heating Output - Other Type of Heating Output - Other Warm air heating

Age of system in years

Type of Heating Output - Other Type of Heating Output - Other underfloor heating

In how many rooms

Hot Water Supply Hot Water Supply cylinders

Size in Litres

Age in years

Hot Water Supply Hot Water Supply combination boiler

Age in years

Cavity Wall Insulation Cavity Wall Insulation yes no

if yes age in years

Loft Insulation Loft Insulation none 100mm 200mm more than 200mm

External Doors External Doors wood upvc composite

Number of External Doors

Age of external doors in years

Windows Windows Wood upvc metal single glazed double glazed triple glazed

Number of windows

Age of Windows in Years

Approximate Fuel Costs per Year (£) ?

Gas

Oil

Electricity

Coal/Wood

Additional Information