HHCRO ESH - Door Knocking Lead Entry
Boiler Type:
*
--None--
ESH
Lead Type:
HHCRO Boiler Lead
Title:
*
--None--
Mr
Ms
Mrs
Dr
Prof
First Name:
*
Surname:
*
Home Phone:
*
Mobile:
Best Time to Contact:
--None--
Morning
Afternoon
Evening
Day Time
Any Time
Property Ownership:
*
--None--
Homeowner
Tenant (with landlords permission)
Landlord (with eligible tenant)
NO SOCIAL HOUSING OR HOUSING ASSOCIATION
Landlord/Tenant Name:
Landlord/Tenant Phone:
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Address:
*
City:
County:
Postcode:
*
ENSURE POSTCODE IS CORRECT TO THE CAMPAIGN
Age of Existing ESH (5+):
*
--None--
Less than 5 years old
5 or 6 years old
7 or more years old
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Property Use:
*
--None--
Residential
Commercial
Mixed use
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Fuel Type:
Electric
Property Type:
--None--
Detached
Semi-detached
Mid-terrace
End-terrace
Bungalow
Maisonette
Park Home
Flat
Mobile Home
If Flat:
--None--
2 external solid walls
3 external solid/cavity walls
No Of Heaters:
--None--
2
3
4
5
6
7
8
9
10+
No of Bedrooms:
--None--
1
2
3
4
5
6 or more
IF BUNGALOW - MUST BE DETACHED
Additional Comments:
***REQUIRED IF CONTRIBUTION IS 'OTHER'
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Eligible Benefits:
*
--None--
State Pension Guaranteed Credit
Income Related Employment & Support Allowance
Income Based Job Seekers Allowance
Income Support
Child Tax Credit
Working Tax Credit
Universal Credit
IF CHILD TAX, WORKING TAX OR UNIVERSAL CREDIT - ENTER NO OF ADULTS AND CHILDREN:
Adults per Household:
--None--
1
2
3 or more
Children per Household:
--None--
1
2
3
4 or more
IF CHILD TAX OR WORKING TAX CREDIT - ENTER GROSS ANNUAL BANDING:
Household Composition + Annual Gross Income:
--None--
1 Adult + up to £13,200
1 Adult 1 Child + up to £17,400
1 Adult 2 Child + up to £21,600
1 Adult 3 Child + up to £25,800
1 Adult 4+ Child + up to £30,000
2 Adults + up to £19,800
2 Adults 1 Child + up to £24,000
2 Adults 2 Child + up to £28,200
2 Adults 3 Child + up to £32,400
2 Adults 4+ Child + up to £36,600
IF UNIVERSAL CREDIT - ENTER NET MONTHLY BANDING:
Household Composition + Net Monthly Income:
--None--
1 Adult + up to £1,100
1 Adult 1 Child + up to £1,450
1 Adult 2 Child + up to £1,800
1 Adult 3 Child + up to £2,150
1 Adult 4+ Child + up to £2,500
2 Adults + up to £1,650
2 Adults 1 Child + up to £2,000
2 Adults 2 Child + up to £2,350
2 Adults 3 Child + up to £2,700
2 Adults 4+ Child + up to £3,050
Consent is given:
*
Memorable Word:
*
Agent:
*
Lead Source:
Door Knockers
Job Required:
New Boiler
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