Name:

Address:
Postcode:

Phone Number: Home Mobile

What is the best time to call you? Morning Afternoon Evening Anytime

Email Address:

Promotion code:

Part 1 — your property

1. Is your home a listed building? Yes No

2. Is your home in a Conservation Area? Yes No

3. Is your home a Flat Bungalow Terrace Semi-detached Detached Farmhouse
Other (please state)

4. When was your house built (eg mid-1800s, 1970s etc)?

5. How many people usually live there?

6. Is there any shading of the proposed roof (eg trees, chimneys, other buildings)? Yes No

7. Installation type Pitched roof Flat roof Ground-mounted system

8. Roof material Slate Concrete tile Stone tile Other (please state)

9. Orientation South South-East South-West East West North

10. Available roof space: m² (approx)

1. Loft insulation Not applicable None <100mm <200mm 270mm or more

2. Cavity wall insulation Not applicable Yes No

3. Hot water tank Not applicable Yes No

4. Pipe lagging Yes Some No

Part 3 — Heating & hot water

1. Main heating fuel Gas Oil Electric LPG Wood Coal
Other (please state)

3. Is this different in summer? Gas Oil Electric LPG Wood Coal Solar thermal
Other (please state)

4. Boiler age Not applicable 1-3yrs 4-7yrs 8-11yrs 12+yrs

5. Do you have a solar thermal system (for hot water)? Yes No

Part 4 — Optional extras

1. Are you interested in these optional extras? Voltage optimisation Wireless generation monitor

Disclaimer
Please note that if you agree to go ahead with a solar PV installation, the contract you enter into will be between you and Fuseland Renewables Limited (or Exenergy Limited in the case of energy efficiency improvements). Neither Llangattock Green Valleys nor Reach For The Renewables, or their representatives, can accept any liability whatsoever in respect of any loss or damage suffered by a purchaser or any other person in respect of goods supplied or installed under this scheme. Llangattock Green Valleys and Reach For The Renewables have provided all information in good faith, but ultimately you are responsible for your own project and any preparatory works deemed necessary. Please also note that prices are subject to change (quotes are valid for 30 days). In addition, as a simple safety precaution, please make sure you check the credentials of any tradesmen visiting your home. Fuseland Renewables Limited and Exenergy Limited staff carry clear identification at all times.

If you have any problems with this form please contact admin@llangattockgreenvalleys.org