Home Energy Savings Kit Loan - Expression of Interest

Please complete this form if you would like to register your interest to borrow a Home Energy Savings Kit for use by your community or community group. The Kit comes with full instructions and will be loaned to groups for a period of 1 week initially. If a group borrows the Kit and would like to request a second or subsequent loan for further use by their community, an additional request should be made on this form and they will be added to the waiting list. This is a valuable item and we request that you respect and care for all items within the Kit. Thank You.

Name of Group borrowing the Kit: (required)

Full name of Group member responsible for the Kit while on loan: (required)

Address: (required)

Phone Number: (required)

Email Address: (required)

Please select the Ballyhoura Development office from which you will be borrowing the HESK. (required)

CappamoreCharlevilleKilmallockMitchelstown

Are you a registered SEAI Sustainable Energy Community? (required)

YesNo, and we would like to be contacted on becoming one.No

By requesting and receiving this Ballyhoura Development Home Energy Savings Kit, I accept full responsibility for care of the items contained within, and to return it in the condition in which I received it. I agree to return the Home Energy Savings Kit a (required)

YesNo

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