NEW BOILER REQUEST FORM

1
Are you a homeowner or a landlord?* This field is required.
HOME OWNERLANDLORD
2
What kind of property do you live in?* This field is required.
FLAT
SEMI DETACHED
DETACHED
BUNGLAOW
TERRACE HOUSE
3
What kind of boiler do you have currently?* This field is required.COMBI BOILERS: Use the the incoming water main and do not utilise storage tanks in the property SYSTEM BOILERS: Use sealed tanks which can be sited anywhere in the property HEAT ONLY BOILERS: Use open tanks in the loft and a hot water cylinder in the airing cupboard BACK BOILER UNITS: Are hidden behind a gas fire and use storage tanks elsewhere in the property
COMBI BOILER
SYSTEM BOILER
REGULAR BOILER
BACK BOILER
4
How would you describe your current boiler?* This field is required.
NOT WORKING
OLD AND INEFICIENT
DOES NOT FIT WITH OUR PLANS
OTHER
5
Is your boiler mounted on the wall?* This field is required.
YES ITS WALL MOUNTED
NO IT IS FLOOR STANDING
6
Roughly how old is your boiler?* This field is required.
Please Select
Please Select
0-10 YEARS
10-15 YEARS
15-20 YEARS
20+ YEARS
7
How long do you see yourself living in your current home?* This field is required.
Please Select
Please Select
0-1 YEAR
1-5 YEARS
6-10 YEARS
10+ YEARS
8
Do you want your new boiler in a different place* This field is required.
YESNO
9
How many bathrooms do you have?* This field is required.
ONETWO+
10
How many separate showers do you have, or plan to have in the future?* This field is required.
NONE
ONE
TWO+
11
How many radiators do you have?* This field is required.
0-5
6-9
10-13
14-16
17+
12
Do you have Thermostatic Radiator Valves on all your radiators?* This field is required.Why do you need them? hermostatic Radiator Valves - or TRVs - are controls for your radiators. They regulate how much hot water flows into the radiator so you can adjust its temperature. TRVs also let you turn some radiators off (for example, in a room you're not using) without turning off the rest of your heating. Building Regulations for England state that whenever a boiler is replaced, every room needs to have thermostatic controls - which means either a thermostat or TRVs. It's important to note that if you have a radiator in the same room as the thermostat, you don't need to have a TRV on that radiator. TRVs are also beneficial because they: • Save you money on heating bills • Use less energy • Are better for the environment
YES
NO
13
Do you have a water meter?* This field is required.
YESNO
14
How quickly does your water come out of your cold tap?* This field is required.
FAST FILLS A PINT GLASS IN UNDER 5 SECONDS
AVERAGE FILLS A PINT GLASS IN UNDER 10 SECONDS
SLOW TAKES MORE THAN PINT 10 SECONDS TO FILL A PINT GLASS
15
Where's your current boiler?* This field is required.
UTILITY ROOM
KITCHEN
GARAGE
AIRING CUPBOARD
OTHER
16
HOW MANY BEDROOMS* This field is required.
Please Select
Please Select
1
2
3
4
5+
17
Where does your flue come out?* This field is required.How to find your flue A flue is like a chimney. It's a pipe that takes waste from your boiler and carries it outside. The flue exit looks a bit like an exhaust pipe, either on the wall or on the roof.
ROOF
WALL
18
Where does your flue come out?* This field is required.How to find your flue A flue is like a chimney. It's a pipe that takes waste from your boiler and carries it outside. The flue exit looks a bit like an exhaust pipe, either on the wall or on the roof.
ROOF
WALL
19
Name* This field is required.
First Name
Last Name
20
Email* This field is required.
example@example.com
21
Phone Number* This field is required.
Area Code
Phone Number
22
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
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Sierra Leone
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Solomon Islands
Somalia
Somaliland
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South Ossetia
South Sudan
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Sudan
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Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
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Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Should be Empty: