TitleMrMrsMr and MrsMissMsDrProfRevFirst Name*Family Name*Company NameEmail* Address* House Name or number Post Code Phone*Where did you first hear of us?Flint and Denbigh ShowAnglesey ShowLocal newspaperGoogleotherHow would you like your estimate?*Desktop survey (free)Site Survey (£75)Project Stage*ResearchObtaining QuotesLooking to Install ASAPProject Timescale*NowWithin 3 Months3 - 6 Months6 - 12 Months12 Months +Existing heating system*Check all that Apply Oil combi Oil and hot water cylinder LPG and combi LPG and hot water cylinder Mains gas combi Mains gas and hot water cylinder Storage heaters Electric panel / underfloor heating AGA / Rayburn Solid Fuel Solid Fuel / Back Burner Other Building Construction - Main Walls*Check all that Apply Brick and cavity filled Brick and cavity unfilled Stone – uninsulated Stone and insulation Solid brick Timber frame Not Sure Building Construction - Windows*Check all that Apply Double Glazed 2003 onwards Double glazed before 2003 Single Glazed Triple Glazing Loft Insulation*Check all that Apply 250mm insulation + Upto 250mm Insulation No insulation No access Don’t know Age of Building*Check all that Apply Pre 1930 1930-1980 1980-2000 2000 Onwards Dwelling Type*Detached houseDetached bungalowSemi detached houseSemi detached bungalowMid TerraceFlat / MaisonetteDormer Bungalow / MewsNumber of Bedrooms*2345+Annual Heating Spend*Less than £1500£1500-£2000£2000-£3000£3000 +Any High consumption items?*Check all that Apply Electric Car Air source heat pump Hot tub / Spa Electric Aga Other None Interested in ...*Check all that Apply Upto 5kw Solar PV £6,000 10kw solar PV £9,995 Air source heat pump £9,000- £12000 Ground source heat pump £15000-£20000 Solar Thermal £5,000 Battery Storage £5,000-£7,000 Retrofit underfloor heating system £5,000-£7,000 Funding of project*Check all that Apply Own funds Interested in finance package Your notes for us ...Photo of front of houseAccepted file types: jpg, jpeg, gif, png, pdf.Photo of rear of houseAccepted file types: jpg, jpeg, gif, png, pdf.Photo of current boiler / heating systemAccepted file types: jpg, jpeg, gif, png, pdf.Photo of hot water cylinderAccepted file types: jpg, jpeg, gif, png, pdf.Plans or other useful filesYou can use this file upload section to load up to 3 files Drop files here or Accepted file types: jpg, jpeg, gif, png, pdf. EmailThis field is for validation purposes and should be left unchanged.
