Broader Group - Application form

Important application information

All fields below marked * are compulsory, please ensure all questions marked * are completed or your application will not be submitted. 

Warm Home Discount Team
Co-operative Energy
Energy House
Athena Drive
Tachbrook Park
Leamington Spa
CV34 6RQ

When you click on the Check your application button at the bottom of the form you will get a chance to review the information submitted. It is then important that you click on the Submit Application button on the next page. You will then receive an email from us confirming receipt of your application. 

Download a PDF version of the application form here that you can print out, complete, and post to us.

Your details













Eligibility criteria

Please ensure you tick your (or your partner's) eligibility from both Section A AND Section B

Section A – In this section please tick any statements which apply to you (or your partner)

Section A Qualifying Criteria










Section B – In this section please tick any statements which apply to you (or your partner)

Section B Qualifying Components











1Please note that there are separate arrangements for those who claim the ‘Guarantee Credit’ or the combined ‘Guarantee Credit and Savings Credit’ element of Pension Credit. If you are eligible under these arrangements, you will have been contacted separately