Greener home packs application form

To claim your free pack, please fill in the questions below. Please ensure you answer all of the questions otherwise, we may not be able to send out your pack.

Some questions are about recycling, your energy bills and SYHA's energy saving projects.

You answers will help us to see how much difference the advice in our packs could make to how green and energy efficient your home is. You will also be helping to shape the advice that we give to other residents.

You are providing this information to us for the purposes of obtaining a 'greener homes pack' only. We will keep a record of this information for our own information only. The personal information you provide to us will not be passed onto any third parties.

Your name *

Your contact telephone number *

Your address *

Line 1 *
Line 2
Town *
County
Postcode *
Country

Your age *

Is your home a *

Number of adults living in your home *

Number of children living in your home *

Do you currently recycle any of the following?

How much (approximately) do you currently spend on your gas? *

Is that per *

week
month
quarter
year

How much (approximately) do you currently spend on your electricity? *

Is that per *

week
month
quarter
year

Does your home have a water meter? *

yes
no

How did you hear about the free 'greener home packs?' *

If 'other' please state where

SYHA is currently running several environmental & energy saving projects to make us a greener organisation. In these projects we often work in partnership with other organisations. Are you interested in being involved in any of these projects? *

Yes please (your details may be given by us to other organisations for environment and energy saving projects only)
Yes, SYHA only (your details will only be used for SYHA projects)
No thank you

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