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Insulation

Application Form

Homeowners, tenants and landlords, please complete the relevant sections of this form.

Name

Street Address

Suburb

Telephone (home)

Telephone (mobile)

Email address

Tick

Are you a homeowner wanting to insulate your home?

Are you a landlord wanting to insulate a rental property?

Are you a tenant wanting to insulate the property you rent?

TENANTS:

If you rent please provide the contact details of the owner (landlord).
Please note: we will not contact your landlord until we have made contact with you.

Landlord’s Name

Landlord’s Address

Landlord’s Telephone

LANDLORDS:

If you own a rental property please provide the contact details of the tenant.

Please note: we will not contact the tenant until we have made contact with you.

Tenant's Name

Address of Rental Property

Tenant's Telephone

Homeowners and/or Tenants: do you hold (or are you eligible for) a Community Services Card (CSC)?

Yes - CSC #

Important:
Do you or your family suffer from any respiratory or other chronic illness that may be alleviated by living in a warmer drier home?

Yes (please specify)

What Health Clinic or Medical Centre do you visit?

Has your ceiling been insulated in the last 10 years?	Yes	No	Unsure

Has you underfloor been insulated in the last 10 years?	Yes	No	Unsure

Is your ceiling easily accessible?	Yes	No

Is your under-floor easily accessible?	Yes	No

Date when house was constructed: (if known)	eg; 1956

How did you hear about the Insulation Projects and/or subsidies?

Any Comments?

Can we contact you about other Sustainability Trust projects and initiatives?

Yes

The Sustainability Trust

Ph: (04) 389 3400

Fax: (04) 389 3411

office@sustaintrust.org.nz

PO Box 7337

Wellington South

Customer Testimonials

Warm Homes - Healthy Homes

"A few weeks ago I had my house insulated ago by Sustainability Trust workers. Now, when I step into the hall in the morning I notice that it’s warmer. When I’ve heated the lounge, since the work’s been done, I’ve just had the heater on low. It’s a good thing that this work is being done in our area."

Warm Homes Recipient June 07

"Recently we have had our house insulated by the Sustainability Trust. We are very grateful to have the work done. At our ages (late 70’s) it would have been impossible for us to have funded the task. My wife has bronchitis and I have emphysema…"

Healthy Homes Recipient Aug 07

"The other day the heater had been on in the living room. We went out for a few hours and found that when we returned that the room was still warm. This would never have happened prior to the insulation being installed. The house also seems quieter…"

Warm Homes Recipient June 07

"Once again I would like to reiterate our gratitude for the task the Trust has undertaken and we wholeheartedly support their aims."

Healthy Homes Recipient Jan 07

"A short note to say, a big thank you to the Sustainability Trust. My home is now snug and warm and draught free. I love it “ long may this work continue”.

Healthy Homes Recipient May 07