Assured Heating Solutions

Application Form

Step 1 of 2

Name*

Email address*

House Name/Number*

Street*

Postcode*

Phone*

Step 2 of 2

House Type*

Detachment*

Flat / Maisonette Walls*

Wall Type*

No of bedrooms*

Heating type*

Boiler type*

Age of boiler*

Flue type*

Ground floor type*

Eligibility*

You may qualify if someone living in your property claims any form of benefit. Alternatively if no one claims a benefit but you live in one of the counties listed

Current heating*

Please upload a picture of your boiler or main heating source