Please enable JavaScript in your browser to complete this form.Name *EmailPhone *AddressIf you or someone in your household DOES NOT claim benefits, you may still qualify. Please select which county you are inConwyDenbighFlintshireOtherSomeone claims benefitsTick the relevant boxes where applicable Child Tax CreditChild BenefitPension Credit GuaranteeESA – Income relatedIncome SupportWorking Tax CreditArmed Forces Independent PaymentAttendance AllowanceCarers AllowanceDLA – Disability Living AllowanceSevere Disablement AllowanceWar Pensions Mobility Supplement changeIndustrial Injuries Disablement BenefitPIP – Personal Independence PaymentConstant Attendance AllowanceJSA – Job seekers Allowance – Income relatedUniversal CreditEPC RATING , F or G – Check on the EPC registerHouse typeSemi Detached HouseDetached HouseTerrace HouseSemi Detached Bungalow Detached Bungalow Age of boilerIs your houseSolid wallsCavity wallsNot sureNumber of bedrooms Selected Value: 0 Is your boilerMains gas OilLPGNo boiler present / electric heatingDate of Birth – This is to check with the energy saving trust if you qualify. By inputting your date of birth you are agreeing for us to check if you qualify. Please leave this blank if you do not wish for us to do this. We can use the rest of the information to try and determine if you qualify. Please enter your date of birth belowWebsiteSubmit