Oil Appliance service plan and insurance Application
Your Details :
Name:
Address
Postcode
Email
Phone
Mobile Phone
Property Details :
Owner /Occupier
Tennant Responsible for Servicing
Tennant not responsible for servicing
Council Letting
Business
School / College
Property Type
If Different From Above
Property Address
Property Postcode
Appliance Details :
Appliance Make
Appliance Model
Appliance Type
Standard Utility Boiler
Standard Combi Boiler
Condensing Utility Boiler
Condensing Combi Boiler
AGA
Esse
Rayburn
Stanley
Redfyre
Commercial Boiler
Other
(If Known)
Kitchen
Scullery
Garage
Cupboard
Outside
Other
Appliance location
(If Known)
Serial Number
(If Known)
Last Service Date
Yes
Do you Have Proof of Service if within 6 months
No
Please Attach proof of Service if available
Name of Service company if attachable form not available
Cover Requirements
With Annual Service
Standard Utility Boiler
Standard kitchen Boiler Service
Standard indoor Combi Boiler Service
Outdoor Combi boiler service
Other Boiler
Aga Service
Rayburn Service
Esse Service
Redfyre Service
Stanley Service
Other Range Cooker
Cover Type
Cover Start Date
Payment Terms
Monthly In Advance
Annually In Advance
Basic Monthly Service / Insurance Cost Before Taxes
Monthly Tax Value
Basic Monthly Service / Insurance Cost After Taxes
Annual Service / Insurance plan Before Taxes
Total Annual Service / Insurance cost After Taxes
Payment Details
Name as on Card
Long Card number
Start Date
MM
YY
Expiry Date
MM
YY
CVC Number
On back of card
Card Details are initially required to help our underwriter carry out security checks and will be confirmed once accepted onto the scheme