Boiler Installation Survey

1

What type of fuel does your boiler use?* This field is required.

Gas

Oil

LPG

Electric

2

What type of boiler do you have?* This field is required.

Combination

Boiler with cylinder and tanks

Boiler with cylinder but no tanks

Back boiler

3

Do you require the same type of boiler?* This field is required.

Yes

No

Don't Know

4

What type of property do you live in?* This field is required.This is the property you would like the boiler to be installed.

Terraced

Bungalow

Detached

Flat

Semi Detached

6

How many bathrooms do you have?* This field is required.

1

2

3 or more

7

When do you need your new boiler?* This field is required.

ASAP

Within 1 Month

Within 3 Months

8

Postcode* This field is required.The post code of the property you would like the boiler to be installed.

9

Your Name* This field is required.

First Name

Last Name

10

Email* This field is required.The email address you would like us to contact you on.

example@example.com

11

Phone Number* This field is required.The best number to contact you on.