Zero Chippenham Thermal Camera loan form
This is a form to request the loan of a thermal imaging camera from Zero Chippenham
How did you hear about this scheme?
Via Zero Chippenham website or comms (default)
Via Chippenham Town Council
Other
Contact details
Name
*
First Name
Last Name
Email
*
Confirmation Email
Note that when you click submit below, you should receive an email from Jotform with a copy of your completed form
Phone number
*
Address
*
Street Address
Street Address Line 2
Town
County
Postcode
Do you need the Android or iPhone version of the Camera?
Please select Android or iPhone
*
Android (usb C)
iPhone
I agree to provide a £20 cash deposit on camera collection, refundable on camera return
*
I will leave £20 cash deposit when I collect the camera, refundable on return
I will bring proof of identity with me when I collect the camera
*
I will bring proof of identity
I am over 18 years of age
*
I am over 18
Is there anything else you'd like to tell us?
We also have a solar scheme and may be able to help with other advice
Please verify that you are human
*
Note that if you have technical difficulties completing the form above, please contact zerochippenham@gmail.com for help. Note also that clicking submit below will mean you should receive an email from Jotform with a copy of your completed form
Submit
Should be Empty: