First Name
*
Last Name
*
Phone Number
*
Email
*
Business Name
*
Street Address
*
Town/City
*
Postcode
*
Address where cover is required (if different to above)
Street Address
Street Address Line 2
Town/City
State / Province
Postcode
What type of energy do your boilers use?
*
Natural Gas (gas meter)
LPG Gas (bottles/tank)
Oil
Electric Only
How many commercial boilers would you like to include?
*
How many domestic-style boilers would you like to include?
*
This refers to a domestic boiler installed in a commercial premises
Would you like to include a commercial catering kitchen gas safety certificate?
Yes
Would you like air conditioning servicing included?
Yes
How many outside condensers similar to the ones in the below images do you have?
How many indoor cassettes/wall units do you have similar to the ones in the images?
How many air conditioning service visits would you like within the 12-month cover period?
One service visit (annually)
Two service visits (six monthly)
Further information (optional)
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