Contact Name *

Position within Company *

Email *

Contact Number *

Address of the site for which you are applying for an energy assessment *

Postcode *

Unique Property Reference Number (UPRN) for the site seeking an audit

if known

Registered Business address if different

To which local authority do you pay your business rates? *

Business established year

Is the company registered on Companies House? Yes No

Please provide your Companies House reference number

Total number of people employed by your business? *

Total number of people employed at the site for which you are applying for an energy assessment?

Describe the primary business activity at this site?

Please,provide your most recent annual turnover figure (£)

Does the organisation's current balance sheet exceed £ 43 million? Yes No

Does a separate enterprise own >25% of the capitol or voting rights? Yes No

Is your organisation a branch of, or affiliated to,any other company? Yes No

Have you had a funded energy review? Yes No

Estimated annual electricity cost/consumption (in £ or kWh)

Estimated annual gas cost/consumption (in £ or kWh)

Other energy consumption (in £ or liters)

Are you responsible for paying your energy bills directly? Yes No

In applying for this scheme you agree to your future participation in monitoring and evaluation activities.*

In applying for this scheme you acknowledge your business data will be shared across third parties.*

This information may be used to facilitate evaluation research,including data matching and monitoring of your energy consumption.

Please read the Data Privacy Policy for full information.

Energy Assessment Registration Form