No Hassle Heating Form
First Name
Last Name*
Phone
Address Line One
Address Line Two
Town/City
County
Postcode
Boiler Make & Model
Boiler Age
Boiler Condition
Reason for Boiler Condition
System Condition
Reason for System Condition
Install Filter
Position of Filter
Gas Rate or Burner Pressure – Actual
Gas Rate or Burner Pressure M.I.'s
Unsafe Situation
Level of Service
Remedial Work Required