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NAME
*
PHONE
*
EMAIL
*
TYPE OF GAS SAFETY CERTIFICATE
Please Choose
Landlord Gas Safety Certificate
Commercial Gas Safety Certificate
Commercial Catering Gas Safety Certificate
LPG Gas Safety Certificate
Mobile Catering Gas Safety Certificate
Building Regulations Compliance Certificate
Not Sure
HOW MANY GAS APPLIANCES (cooker, boiler, grill, gas fireplace, water heater, ect) DO YOU HAVE?
Please Choose
I do not know
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
more than 15
JOB ADDRESS / SITE ADDRESS
SITE CONTACT (For example tenants name and number or pub manager name and number, or building site manager name and number.)
TYPE OF PROPERTY?
Please Choose
Flat, House
Shop
Takeaway
Pub
Restaurant
Office
Warehouse
Care home
Nursery
School
Cafe
Hotel
Other
HOW SOON DO YOU NEED IT?
Please Choose
Urgently Today
ASAP
This Week
Next Week
Within a month
PREFERRED DAYS (Please feel free to choose more than one day.)
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
PREFERRED TIME (Please feel free to choose more than one, OR if it is easier for you to specify preferred time with your own words, you can do it further below.)
*
7-9AM
9-11AM
11AM-1PM
1-3PM
3-5PM
5-7PM
9-5PM
INVOICE NAME / COMPANY NAME
*
INVOICE ADDRESS (Full address including post code.)
PREFERRED PAYMENT TYPE?
*
Please Choose
Cash
Bank transfer
Cheque
Paypal
Card
VAT REGISTERED
Please Choose
Yes
No
WHY DO YOU NEED A GAS SAFETY CERTIFICATE
Please Choose
I am a landlord and renting a property
I am an estate agent and need a gas safety
I am selling my property
Council asked for the certificate
Lawyer asked for the certificate
Insurance company asked for the certificate
Other
Any special requirement or comments
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