New Electric Boiler Lead

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For an electric boiler quote, we just need a few details

For an electric boiler quote, we just need a few details

1
First Name* This field is required.
2
Last Name* This field is required.
3
House Name or Number* This field is required.
4
Address Street* This field is required.
5
Address Town/City* This field is required.
6
Postcode* This field is required.
7
Your Phone Number* This field is required.
8
Your Email* This field is required.
9
What would you like a quotation for?* This field is required.For instance - ‘New electric boiler to replace my gas boiler’ please provide as much details as possible
Huge
Large
Normal
Small
Ok
Ok
10
How many radiators do you have?* This field is required.Including towel rails
11
How many baths do you have?* This field is required.
12
How many showers do you have?* This field is required.
13
Do you have an electric shower?These usually have a pull switch to turn on the power
YESNO
14
When do you require a boiler replacement?
Urgently
Within 1 month
1-3 months
Over 3 months
Unknown - I am just enquiring what the cost would be
15
So we can guarantee the lowest quote, please attach a received quote Also helps you compare like-for-like
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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16
What is the distance between the new boiler position and your fuse/trip-switch box?
0-2 metres
2-4 metres
4 + metres
17
Please take/upload some photos of your current boiler/hot water tank * This field is required.Please include photos of any data/information too
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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18
Please take/upload some photos of your fuse/trip-switch box* This field is required.If there's a cover, please remove this so we can inspect the trip-switches/fuses inside
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
19
Please take/upload a photo of a radiator/heater (if applicable) Try and include they pipework too
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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