FREE Boiler application form

Blue Gas is working in association with Vaillant boilers with backing from one of the BIG 6 energy companies to replace faulty & inefficient boilers with high efficiency "A rated" condensing boilers and combination boilers free of charge.

Installation is subject to survey and to be eligible for the scheme you need to live in either a privately rented property or own your own home and be in receipt of certain qualifying benefits.

Private landlords can also enquire as your tenants could be eligible. This could mean you get a new boiler fitted at your properties completely free of charge. There is no limit to the number of properties you could have.

To see if you qualify complete the simple form below (takes 2-3 minutes) and we will get back to you.

*The first 5 fields are mandatory but the more information your give us the quicker we will be able to deal with your application.

OPTION 1 - Stand Alone Benefit (either one will qualify)
State Pension Credit
Child Tax Credit, relevant income below £15,860
 
OPTION 2 - Please tick any of the following (1 & 2 cannot be combined)
Income based job seeker's allowance
Income related employment and support allowance
Income support
Plus please tick any ONE of the following
N/A - Clear all
Disabled child premium
Parental responsibility for a resident child under 16
Parental responsibility for a resident child 16-20 in full time lower education
Pension - higher, premium or enhanced pension
Child tax credits that include disability or severe disability elements
Disability, enhanced or severe disability premium
A work related activity or support component with income related allowance
 
OPTION 3
You need to receive
Working tax credit with income below £15,860
Plus at least one of the following (tick all that apply)
Parental responsiblility for a resident child under 16
Parental responsibility for a resident child 16-20 in full time lower education
Receive a disabled worker or severe disability element
Be aged 60 or over
 
To send - Please click the "submit" button when your form is complete.
Your Name*
Are you a homeowner / privately renting / a landlord*
Property address*
Telephone or Mobile number*
Email address*
Landlord's name (if applicable)
Landlord's phone number (if applicable)
Where did you hear about this scheme
Boiler make and age (if known)
Boiler location EG Kitchen / Bedroom / Bathroom / Garage etc
Property type EG detached / semi-detached / terraced / bungalow / flat etc
Any other relevant information