Magnatech Site Survey Form

Please complete all fields as accurately as possible.

* fields are mandatory.

Company Name

Installation Quotation Authorised by

Address for Installation

Contact Email Address

example@example.com

Contact Phone No. Office

Contact Phone No. Mobile

Annual Consumption Data Available?
*

If Yes, then do you also receive gas emissions analysis?
*

Thermostat on System (Y/N)*

Separate Meter for System (Y/N)*

Boiler 1: Brand and Model Number

Max Output in kWh or BTU*

Boiler 2: Brand and Model Number

Max Output in kWh or BTU*

Boiler 3: Brand and Model Number

Max Output in kWh or BTU*

Fuel Intake Pipe Diameter sizing

Closest to Burner (mm)

Second Section (mm)

Fuel Intake Pipe Clear Length (mm)

PLEASE ALSO PROVIDE PHOTOS OF THE INLET GAS/OIL/LPG PIPES

Please submit the completed form by clicking the link below or email to: info@magnatechsystems.com