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CLAIM YOUR FREE LOW ENERGY LIGHT BULB AND HELP COMBAT CLIMATE CHANGE
First Name
Last Name
Address:
City:
Postcode:
Telephone:
optional
Email:
optional
optional
Do you receive any income support or benefits?
income support
housing benefit
council tax benefit
income based jobseekers allowance
attendance allowance
disability living allowance
disablement pension benefit (incl. constant attendance allowance)
war disablement pension (incl. mobility supplement or constant attendance allowance)
pension credit
child tax credit (where the relevant income is £14,600 or less)
working tax credit (where the relevant income is £14,600 or less)
Electricity meter readings during the last year:
Please provide as many readings as possible as the more information we have, the more accurately we can see how much energy you are saving.
To claim your free light bulb, we need a meter reading from 12 months ago
and
your current reading.
12 Months ago:
kWh or Units
9 Months ago:
kWh or Units
6 Months ago:
kWh or Units
3 Months ago:
kWh or Units
You can find these on your old electricity bills
Electricity meter reading
now
kWh or Units
What kind of bulb are you replacing?
Bayonet
Screw
(Bayonet)
(Screw)
Wattage
30
40
50
60
75
100
Other Details
Please tell us if you have bulbs with small bayonet/screw or unusual fittings:
How did you hear about the FREE bulb offer?
Please note
: the light bulbs we supply for FREE are
NOT
suitable for use with dimmer switches.
Privacy Policy
: We will
NEVER
pass your details onto third parties.