Free Boilers & Insulation for Ayrshire residents - Apply NowComplete our questionnaire below... Please enable JavaScript in your browser to complete this form.Measures - Step 1 of 7What measures are you interested in? Click all that apply. *Replacement Gas BoilerInsulation UpgradeFirst Time Gas Central HeatingOtherNextDoes anyone in your household receive a state benefit (including Child Benefit)?YesNoIf yes, please tell us what type of benefit it is. Click all that apply.Carer's allowanceChild BenefitChild Tax CreditsDisability living allowanceUniversal CreditWorking Tax CreditsIncome-related employment & support allowance (ESA)Other benefitNo benefitsPreviousNextWhat is your house type? *Detached HouseSemi-Detached HouseMid-Terrace HouseEnd-Terrace HouseDetached BungalowSemi-Detached BungalowFlatOtherPreviousNextHow many bedrooms do you have? *1 Bedroom2 Bedrooms3 Bedrooms4 Bedrooms5 Bedrooms6+ BedroomsPreviousNextWhat is your current heating type? *Gas Combi BoilerGas System BoilerGas Back BoilerElectric Storage HeatersPortable Electric HeatersOther / I'm not surePreviousNextCustomer Name *FirstLastAddress *Town *Postcode *Customer Telephone *Customer Email *PreviousNextHow did you hear about us? *FlyerRecommendationInternet search engine (eg. Google)TVRadioSocial media (eg. Facebook)Shelter ScotlandOtherAny other comments or queries?We will never share your details with third parties without your permission. By completing this form you consent to the processing of personal data in accordance with our Privacy Policy which can viewed at: www.greenhomesystems.co.uk/privacy-policy *I accept the Privacy PolicySubmit
