ENERGY ASSESSMENT

Business Name & Address
Contact name	Tel no
Email address	No of employees
Estimated size of premises (sq. m)
No of rooms
Preferred day of assessment (please tick your preferred day of assessment and denote whether you would prefer an AM or PM slot – appointments are between 9-4pm)	AM/PM
Monday
Tuesday
Wednesday
Thursday
Friday
Please add any additional information
Please type your name	Date
By signing your name and forwarding this application to Burgess Hill Town Council, you accept all the Conditions as detailed above.
Please return completed form to: Gemma Wallis Burgess Hill Town Council 96 Church Walk Burgess Hill, RH15 9AS	Email: gemma@burgesshill.gov.uk Tel: 01444 247726