Sustainable Warmth Scheme form

By completing this form you confirm that you meet the criteria for this scheme, and agree to us processing your provided data in lines with our privacy policy.

About you

What best describes this expression of interest? *

I am completing this form on behalf of myself / my household
I am completing this form on behalf of someone else / another household

I confirm that this household pays council tax to Shropshire Council *

I confirm that I/they have been a resident for more than 6 months *

I confirm that the household does not have access to mains gas *

Your details

Your full name *

Your relationship to the person you are acting on behalf of *

Your contact number *

Your email address *

Details of household

Full name of applicant *

First line of address *

Town *

Postcode *

Date of birth *

How many adults live here? *

How many children live here? *

Email address *

Telephone number *

Have you received an energy efficiency grant via a Shropshire Council scheme within the last 2 years? *

Yes
No

Contact preferences

How would you prefer to be contacted? *

Phone
Email

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Sustainable Warmth Scheme form

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