EmailMeForm
Assessments by Green Deal Approved Assessors
www.greendealprotection.co.uk
FREE GRANTS Find out if you also qualify for The Energy Company Obligation ECO free assistance or subsidised HELP
1. Name
*
First
Last
1a. Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
2. Phone
*
3. Email
*
4. Are you a:
*
Please select
Homeowner
Landlord
Private Tenant
Council Tenant
Social Housing Tenant
5. Is your property a:
*
Please select
Detached
Semi-Detached
Mid Terrace
End Terrace
Flat
Other
7. Is your home:
*
Please select
A listed building
In a conservation area
In an AONB
Have planning restrictions
None
What Fuel heats your home:
*
Please select
Gas
Electric
Oil
Coal
LPG
Other
9. Who is your current
electricity supplier
*
Please type in name of supplier i.e. EON
10. Do You or anyone living in your home receive any
of the following?
Tick all that apply
*
Child Tax Credit with relevant income below £16,190
State Pension Credit
Income Support or Income Related ESA or JSA
Disability i.e. child or higher premium for care/mobility
None
11. What green deal measures are you interested In?
Tick All that Apply
*
Loft Insulation
Cavity Wall Insulation
Solid Wall Insulation
Condensing Boilers
Renewables
Heating Controls
Other
Please say what other measures are at No 17. below
12. What is your primary heating source
*
Please select
Gas
Oil
Electric
Other
13. Can the Assessor discuss other products and services that can save you money
*
Yes
No
i.e. Free products; cost saving lighting; discounts
14. Do you have any of the following energy efficient
or saving products?
Tick all that apply
*
Loft Insulation
Cavity Wall Insulation
Solid Wall Insulation
Condensing Boiler
Renewables
other
15. Message
Put any other information you believe is relevant in this box or if you wish to add to the information provided above