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Energy Efficient Historic Home

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1. Please give us your contact details.

Please give us your contact details. Name:
Address:
Postcode:
Email Address:

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2. Property Information

	Property Ownership	Property Type	Year of Construction	Listed Building
Choose	Property Information Choose Property Ownership	Property Type	Year of Construction	Listed Building

3. Building Details

	Walls	Loft Insulation
Choose	Building Details Choose Walls	Loft Insulation

4. Windows

Windows Single Glazing

Double Glazing

Secondary Glazing

Draft Proofing

Wooden Shutters

Blinds

Curtains

Other

5. Window Frames

Window Frames PVC

Metal

Wooden

6. Further details

	Ventilation	Heating	Hot Water Source	Energy Efficient Lighting
Choose	Further details Choose Ventilation	Heating	Hot Water Source	Energy Efficient Lighting

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7. Behaviours

	Always	Often	Sometimes	Never
Use Curtains/Blinds/Shutters	*Behaviours Use Curtains/Blinds/Shutters Always	Use Curtains/Blinds/Shutters Often	Use Curtains/Blinds/Shutters Sometimes	Use Curtains/Blinds/Shutters Never
Leave electrical appliances in stand-by	Leave electrical appliances in stand-by Always	Leave electrical appliances in stand-by Often	Leave electrical appliances in stand-by Sometimes	Leave electrical appliances in stand-by Never
Turn lights off when a room is empty	Turn lights off when a room is empty Always	Turn lights off when a room is empty Often	Turn lights off when a room is empty Sometimes	Turn lights off when a room is empty Never
Use a thermostat/timeclock	Use a thermostat/timeclock Always	Use a thermostat/timeclock Often	Use a thermostat/timeclock Sometimes	Use a thermostat/timeclock Never
Take a shorter shower instead of a bath	Take a shorter shower instead of a bath Always	Take a shorter shower instead of a bath Often	Take a shorter shower instead of a bath Sometimes	Take a shorter shower instead of a bath Never
Put a lid on the saucepan while cooking	Put a lid on the saucepan while cooking Always	Put a lid on the saucepan while cooking Often	Put a lid on the saucepan while cooking Sometimes	Put a lid on the saucepan while cooking Never
Do 30 degree washes	Do 30 degree washes Always	Do 30 degree washes Often	Do 30 degree washes Sometimes	Do 30 degree washes Never
Recycle	Recycle Always	Recycle Often	Recycle Sometimes	Recycle Never
Compost	Compost Always	Compost Often	Compost Sometimes	Compost Never
Throw away uneaten food	Throw away uneaten food Always	Throw away uneaten food Often	Throw away uneaten food Sometimes	Throw away uneaten food Never

8. Transportation

	Always	Often	Sometimes	Never
Walk	*Transportation Walk Always	Walk Often	Walk Sometimes	Walk Never
Cycle	Cycle Always	Cycle Often	Cycle Sometimes	Cycle Never
Use public transportation (bus/train)	Use public transportation (bus/train) Always	Use public transportation (bus/train) Often	Use public transportation (bus/train) Sometimes	Use public transportation (bus/train) Never
Car sharing	Car sharing Always	Car sharing Often	Car sharing Sometimes	Car sharing Never
Car	Car Always	Car Often	Car Sometimes	Car Never

9. Are you interested in...?

	Very interested	Slightly interested	Not interested
Saving energy (and money)	*Are you interested in...? Saving energy (and money) Very interested	Saving energy (and money) Slightly interested	Saving energy (and money) Not interested
Available grants	Available grants Very interested	Available grants Slightly interested	Available grants Not interested
Renewable energy: solar, wind, hydro, biomass	Renewable energy: solar, wind, hydro, biomass Very interested	Renewable energy: solar, wind, hydro, biomass Slightly interested	Renewable energy: solar, wind, hydro, biomass Not interested
"Green" activities and events	"Green" activities and events Very interested	"Green" activities and events Slightly interested	"Green" activities and events Not interested
Community projects	Community projects Very interested	Community projects Slightly interested	Community projects Not interested

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10. Would you like to receive further information by email?

Would you like to receive further information by email? Yes

No

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