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.