Customer Survey Form For Central Heating Boilers.
Thank you for enquiring about a P.Brayford and Father central heating boiler.
It will help us greatly to assess the suitability of your property and to give you an estimate for installing A new boiler if you could complete our questionnaire.
Title Mr Mrs Miss Dr Rev Other Surname First Names
Address Post Code
Phone Number Mobile
Email
House details.
House type Terrace Bungalow Semi Detatched Flat No. of bedrooms 1 2 3 4 5 More No. of bathrooms 1 2 3 4 More
No. of other rooms 1 2 3 4 5 6 7 More Other
Approximate age of house 0 to 15 15 to 30 30 to 45 45 to 60 60 + How many people live in your household? 1 to 2 2 to 4 4 to 6 more
Existing Heating System.
Existing boiler type? Combination boiler Wall hung boiler Floor standing boiler Back boiler and fire Other If other please specify
Do you have a working hot water cylinder? Yes No If yes is it Vented (Stored water in loft) Un-vented (mains water preasure) Other
How is your hot water and heating heated at present? Gas boiler Oil boiler Soild fuel LPG boiler Electric imersion Other If other please specify
How old is the existing boiler 5 to 10 10 to 20 15 to 20 20 to 25 25 to 30 Older How old is the existing system 5 to 10 10 to 20 15 to 20 20 to 25 25 to 30 Older
How many existing radiators
New Heating System.
New boiler required? Combination boiler System boiler Is the new boiler going back in the same place Yes No
Do you require new T.R.V.s and lock shield radiator valves? Yes No If yes please specify
Do you require new radiators? Yes No If yes please specify
Do you require a new hot water cylinder Yes No Dose the system need updating Yes No
Any questions you may have