ECO4 Enquiry FormECO4 Enquiry Form Leave this field blank First Name Surname Address Post Code Telephone Number Email Address State what your interested in Cavity Wall Insulation Loft Insulation External Wall Insulation Internal wall insulation Room in Roof Insulation Solar Panels Gas Central Heating System High Heat Retention Electric Storage Heaters Air Source Heat Pump Removal of existing wall insulation (payable) State your tenure state owner or tenantHomeownerPrivate Tenant State what type of property State type of propertyA Park Homea Flata maisonettea mid terraced housean end of terrace housea semi-detached housea detached housea mid-terrace bungalowan end of terrace bungalowa semi-detached bungalowa detached bungalow State what type of heating you use State type of heatingMains Gas BoilerGas Room HeatersOil BoilerCoal Boiler (eg Parkray, Rayburn)LPG Boiler (Tank)LPG Boiler (Bottles)Coal FiresElectric Storage HeatersElecrtic Panel HeatersElectric BoilerAir Source Heat Pump State how many adults live at the property? state number of occupants12345+ Age of eldest occupant Does anyone living at the property receive a Government Benefit? if so state type of benefit State you Total Gross Household Income state total Gross Household IncomeLess than £31,000More than £31,000 Does anyone living at the property suffer from a medical condition? if so please give details. This could qualify for LA Flex. Additional Notes (optional) Do I Qualify?