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Boiler Form
1
What type of fuel does your boiler use?
*
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Gas
Oil
LPG
Electric
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2
What type of boiler do you have?
*
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Combination
Boiler with cylinder and tanks
Boiler with cylinder but no tanks
Back boiler
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3
Do you require the same type of boiler?
*
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Yes
No
Don't Know
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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
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5
How many bedrooms do you have?
*
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1
2
3
4
5 or more
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6
How many bathrooms do you have?
*
This field is required.
1
2
3 or more
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7
When do you need your new boiler?
*
This field is required.
ASAP
Within 1 Month
Within 3 Months
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8
Postcode
*
This field is required.
The post code of the property you would like the boiler to be installed.
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9
Your Name
*
This field is required.
First Name
Last Name
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10
Email
*
This field is required.
The email address you would like us to contact you on.
example@example.com
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11
Phone Number
*
This field is required.
The best number to contact you on.
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