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Enquiry Form
Client Name:
Client Email:
Client Phone:
Property Address Line 1
Property Address Post Code
Property Type
Detached
Semi-Detached
End-Terrace
Mid-Terrace
Enclosed End Terrace
Enclosed Mid Terrace
Bungalow
Flat
Maisonette
Park Home
Present EPC (If Known)
A
B
C
D
E
F
G
No EPC Rating
Present EPC Expiry Date (If Known)
On Eligible Benefit
Yes
No
Eligible Benefit Type
Pension Credit
Housing Benefit
Income Based ESA
Universal Credit
Income Support
Jobseekers Allowance
Child Tax Credit
Working Tax Credit
Child Benefit*
* Child Benefit Income Based
1 Parent & 1 Child under £19,800 household income
1 Parent & 2 Children under £24,600 household income
1 Parent & 3 Children under £29,400 Household Income
1 Parent & 4 Children under £34,200 household income
Couple & 1 Child under £27,300 household income
Couple & 2 Children under £32,100 household income
Couple & 3 Children under £36,900 household income
Couple & 4 Children under £41,700 household income
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The Wesley Centre, Rotherham, South Yorkshire S66 8JD
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