Apply for a Gas Service & Breakdown Plan

Please complete the details below to apply for a Service & Breakdown Plan

You need to tick both boxes on the declaration

Your Details

Account No

Title

First Name

Surname

Email Address

Phone

Mobile

Contact me

Billing Details

Delivery Address

Town/City

County

Post Code

Appliance Address (if different)

Town/City

County

Post Code

Plan Cover & Boiler Details

Plan Cover

Boiler Make

Boiler Model

Age of Boiler

Age of pipework, radiators

Is a water descaler fitted?

Location of the Boiler

Date of last Service

Have Tincknells Serviced It?

Property Details

Property Type

Number of Floors

Number of Bathrooms

Number of Bedrooms

Parking Avaliability for the Engineer

It is your duty to provide us with all the facts and to update this information where relevant between the initial enquiry and the attachment of any cover and suring the term of the plan. It is your duty to ensure that the facts and information are correct, complete and up to date. If you are in any doubt as to whether information is material you should disclose it.

Declaration

I confirm that my boiler and heating system are in good working order and I agree to the full terms & conditions for the plan.

I am aware that I shall recieve confirmation on the acceptance of my plan, and that cover will not commence until one month after both the application and a completed direct debit form have been received.

Please enter the code below

Code:

Click here to download a direct debit form