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* 1. What is your name and address?

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* 2. How old is your house?

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* 3. What type of house do you live in?

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* 4. Do you have a current Energy Performance Certificate? If so, what rating does your home have? (please enter A-G and/or 1-92+)

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* 5. Do you have any of the following?

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* 6. Please tell us more if you have other measures in place, and any info you have about when double glazing, insulation or solar power were installed

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* 7. Which of the following do you have at home:

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* 8. How old is your current boiler, if you have one?

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* 9. In the last 12 months, how much energy have you used for heating and electricity? (litres of oil, or kWh for gas) (kWh for electricity)

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* 10. Do you have any other comments or questions about energy use or the project?

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