Tincknell Plumbing and Heating - Boiler Care Cover


Please complete the form below

 

  Required  
Name *
Address *
Postcode *
     
Contact number *
e-mail address  
     
Boiler make *
Boiler model *
Installation date *
Approx age of boiler *
Age of heating system
(pipe work, radiators etc)		 *
     
Date of last service *
Approx number of breakdowns
in last 3 years		 *
     
Are you an existing customer? *
Account number (if known)  
Please select level of cover *
How did you hear of us? *
Have you within the last 5 years, been convicted of arson or any offence involving dishonesty of any kind? e.g. fraud, robbery, theft or handling of stolen goods *
I have read and understand the insurance declaration *
 
I confirm that my boiler and heating system are in good working order and i agree to accept the plan subject to the full terms and conditions which i am aware are available on request. *
     
   

 Insurance Declaration - Important read me.