Zero Chippenham Thermal Camera Free Loan form

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 CouncilOther
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
Should be Empty:

Zero Chippenham Thermal Camera loan form