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Contact Name:

Address Line 1:

Address Line 2:

Town:

County:

Post Code/Zip Code:

Country:

Telephone number(s):

E-mail Address:

Verify E-mail Address:

Building Information

Building(s) to be heated:

Approx total volume of building(s) to be heated:   Cu. m or Cu. ft: Cu m Cu ft

Approx age of building:

Standard of insulation: Good   Average   Poor

Output of existing boiler:  Kw or Btus/hr: kW Btus

Is it adequate: Yes   No

Fuel Information

Main fuels to be used:

Source of fuel: Own   Bought In

Site Information

Boiler Site: Adjoining building or lean to  Outbuilding

FARM 2000/Teisen Products Ltd, Bradley Green, Redditch, Worcs. B96 6RP UK
Tel: 0044(0)1527.821621 Fax 0044(0)1527.821665