Customer Questionnaire

Customer Information

• Name?

• Address?

• Email Address?

• Contact Number?

Property Information

• Do you own your property

  Yes

  No

  Other

• Whom Does?

• Have you previously received any Government Funding towards your Heating System?

  Yes

  No

  Other

• YOU ARE NOT ELIGIBLE FOR £5k BUS VOUCHER!!!

• What type of Funding did you receive?

• Type of Property?

  Select Detached Semi-Detached Mid-Terraced End- Terraced Bungalow Semi-Detached Bungalow Top Floor Flat Middle Floor Flat Ground Floor Flat Barn Commercial

  • Detached
  • Semi-Detached
  • Mid-Terraced
  • End- Terraced
  • Bungalow
  • Semi-Detached Bungalow
  • Top Floor Flat
  • Middle Floor Flat
  • Ground Floor Flat
  • Barn
  • Commercial

• Age of Property?

• Heated Conservatory?

  Yes

  No

  Other

• What is it?

• Number of Floors?

  1 Floor

  2 Floors

  3 Floors

  4 Floors

• Number of Bedrooms?

  Select 1 2 3 4 5 6 7 8 9+

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9+

• Number of Bathrooms?

  Select 1 2 3 4 5 6 7 8 9+

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9+

• Number of Tenants?

  Select 1 2 3 4 5 6 7 8 9+

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9+

• How many Radiators in Property?

• What size Pipework to Radiators

  8mm

  10mm

  15mm

  22mm

• Roof Type?

  Pitched

  Flat

  Sloped

  Conversion

• Is the Loft Area Insulated?

  None

  Less than 50mm

  50mm to 150mm

  More than 150mm

• Main Floor Type?

  Solid Ground Floor

  Suspended Timber Floor

• Is there any Insulation?

  Yes

  No

  Other

• What is there?

• Wall Type?

  Select Solid Brick Cavity (With Insulation) Cavity (No Insulation) Granite Pre-Fab Other

  • Solid Brick
  • Cavity (With Insulation)
  • Cavity (No Insulation)
  • Granite
  • Pre-Fab
  • Other

• What type?

• Electric Price - (p/kWh)

• Electric Standing Charge - (Pence Per Day)

• Do you have PV Solar Panels?

  Yes

  No

  Other

• What do you have?

• Current Fuel Type?

  Gas

  Oil

  LPG

  Other

• What type of Fuel?

  Yes

  No

• Fuel Price - (p/kWh)

• Fuel Price - (Pence Per Day)

• Do you have a current Energy Performance Certificate (EPC)?

  Yes

  No

Existing Heating Information?

• Current Heating?

  Combi Boiler

  Heat Only Boiler

  System Boiler

  Electric Boiler

  Other

• Make & Model?

• Position of Boiler?

• Type of System?

• Position of System?

• Do you have a Cylinder?

  Yes

  No

• Position of Cylinder?

• What produces your Hot Water?

Electrical Information?

• Position of the DB?

• Size of Fuse? (Generally Black Box, Beside Meter)

New ASHP Location?

• ASHP Position? (Clearances = 700mm Front & 300mm Sides)

• Is the Ground Firm?

  Yes

  No

• What are alternatives? (Could it be Wall Mounted)

• Buffer Position? (Half size of microwave)

• Cylinder Position?

Any Other Information

• Is there any other information?