The AT Heating Modul online survey data sheet Full Name* Company (Group) E-mail* Phone* Property function* Please select Residential property Family house Apartment Commercial building Workshop Hall Other Floor area (m2)* Please select Under 50 50 - 70 70 - 90 90 - 110 110 - 140 140 - 170 170 - 200 Above 200, enter the exact floor area data in the comments section Inner height (m)* Please select 2,6 m 2,7 m 2,8 m 2,9 m Above 3 m, enter the exact floor area data in the comments section Insulation thickness (cm)* Heated cubic meter (m3) Number of levels 1 2 3 3 + The building's early years* Please select Less than 10 Between 10 and 20 Over 20 Status of shutters Excellent Good Average Bad Comment County* Please select Avon Bedfordshire Berkshire Buckinghamshire Cambridgeshire Cheshire Cornwall Cumbria Derbyshire Devon Dorset Durham Essex Gloucestershire Greater London Hampshire Herefordshire Hertfordshire Isle of Wight Kent Lancashire Leicestershire Lincolnshire Merseyside Norfolk Northamptonshire Northumberland Nottinghamshire Oxfordshire Rutland Schools Shropshire Somerset Staffordshire Suffolk Surrey Sussex Tyne and Wear Warwickshire West Midlands Wiltshire Worcestershire Yorkshire The address of the property Place* Postal code* Current output of meter: Phase 1. (Ampere)* Phase 2. (Ampere)* Phase 3. (Ampere)* Annual electricity consumption (kWh) Annual electricity bill (GBP) Gas boiler output (kWh) Annual gas consumption (m3) Annual gas bill (GBP) Comment Domestic hot water with gas Yes No Other heating Multi-fuel boiler Fireplace Heating-cooling air conditioning Heat pump Infra panel Pellet boiler Radiator type Plate Cast iron Heating pipe system material Copper Iron PVC Do you have underfloor heating? Yes No Do you have a solar collector? Yes No Do you have a solar panel? Yes No When is the earliest we can get in touch? Can we contact you via email? Yes No Best time to get in touch 9.00 - 12.00 12.00 - 16.00 16.00 - 20.00 WEEKEND I have read and agreed to the Personal data processing . Submit
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