Becker Boiler Service Pre-Payment Form

Becker Boiler Service Pre-Payment Form

Wisconsin’s most trusted boiler experts. Please complete this form to pre-pay for your boiler diagnostic service with Becker Boiler.
Customer Name*

First NameLast Name
Company Name (optional)
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
Service Location
Property Name
On Site Contact Name

First NameLast Name
On Site Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Service Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Description of Issue
Please confirm the following acknowledgments:
I understand this flat fee includes up to four man-hours of onsite work
I understand additional work beyond the included four man-hours may be billed separately using standard rates
Parts, materials, and consumables are not included in the flat rate
I understand Becker Boiler guarantees an accurate diagnosis or the flat rate amount will be refunded in full
I agree to Becker Boiler's standard terms and conditions (enclosed)
Service Options*
prevnext( X )
Weekday Boiler Diagnostic (M-F 7AM - 3:30PM) — $795
Includes up to 4 man-hours of onsite diagnostic, troubleshooting, and repair work with guaranteed accurate diagnosis or full refund.

$795.00

After-Hours / Weekend Boiler Diagnostic — $1,195
Includes up to 4 man-hours of onsite diagnostic, troubleshooting, and repair work with guaranteed accurate diagnosis or full refund.

$1,195.00

Subtotal

$0.00

Tax

$0.00

Total

$0.00
Should be Empty:

Becker Boiler Service Pre-Payment Form

Service Location

Please confirm the following acknowledgments: