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Enquiry form
I would like to find out more about arranging a free home energy efficiency assessment for:
Please select
Insulation
Central heating
Insulation and Central Heating
Home energy check – currently limited to Havering Romford Town ward residents only
Title:
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Mr
Mrs
Miss
Ms
First name:
Last name:
Address:
Postcode:
Tel:
Email:
My local council is:
Are you over 70 years:
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Yes
No
Are you in receipt of a state benefit:
Please select
Yes
No
If yes please select:
Please select
Income Support
Pension Credit
Housing Benefit
Council Tax Benefit
Child Tax Credit (with income less than £16,040)
Working Tax Credit (with income less than £16,040 which must include a disability element)
Job Seekers Allowance
Attendance Allowance
Disability Living Allowance
Industrial Injuries Disability Allowance (with constant attendance allowance)
War Disablement Pension (with constant attendance allowance)
Do you have children under 16:
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Yes
No
Is your property:
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Privately owned
Rented from a private landlord
Owned by council or housing association
How did you find out about us:
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Council magazine
Local newspaper
Billboard poster
Bus
Council offices
Leaflet
Poster
Voluntary organisation
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