Multi Fuel/Boiler Appliance

Please fill in what you can (if you can't or don't want to please leave parts blank) and hit "SEND FORM".
If you have any queries about any questions etc., please send us an email or telephone 01372 466135 leaving your name and telephone number.

Your Boiler / Appliance
Did you buy a multi fuel boiler or appliance?	Please choose... Yes No
What fuel or fuels does it use?
What sort of multi fuel boiler or fire did you buy?
Name of appliance:
Manufacturer:
Model and/or serial number:
When did you buy it?
Month:	Select month... January February March April May June July August September October November December
Year:	Select year... 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980
Who did you buy it from? (Ideally name and address)
The Installation
Who installed it for you? (Ideally name and address)
When was it installed?
Month:	Select month... January February March April May June July August September October November December
Year:	Select year... 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980
Was the person who installed it HETAS registered?	Please choose... Yes No Not sure
If 'Yes', please give HETAS number if possible:
Please note that the firm and the person should both be registered so if you have another number for the firm please give that too.
HETAS number of firm:
If the appliance was installed by a HETAS engineer did you receive an installation certificate?	Please choose... Yes No Not sure
If not HETAS registered, was this person qualified in some other way?	Please choose... Yes No Not sure
If 'Yes', please give details:
If you did not use a person who was qualified why was this?	Please choose... Assumed they were qualified Didn't think about it at all Didn't know how to find out Unqualified person was cheaper Other (please specify below)
Further information:
If the appliance was installed by a non HETAS engineer, did they ensure an application for Building control was made?	Please choose... Yes No Not sure
Did they issue a completion certificate?	Please choose... Yes No Not sure
The Fire
Was the fire satisfactory?	Please choose... Yes No
If you wish to elaborate please do so here:
Have you still got the fire?	Please choose... Yes No
Is the fire in the original condition?	Please choose... Yes No It has been repaired or changed
Do you wish to complain about the fire?	Please choose... Yes No
Do you wish to complain about the installation of the fire?	Please choose... Yes No
About Your Solicitor
If you have already complained and used a solicitor or similar, please ideally give us the solicitor's name and address and ideally email address and telephone number (giving us these details also states that you do not mind us getting in touch with them). Alternatively, please give your solicitor this form and ask them to contact us.
Solicitor's Name:
Solicitor's Address:
Solicitor's Email:
Solicitor's Telephone:
About You
Name:
Address:
Email:
Telephone:
Do you give us permission to pass this form onto the Health and Safety Executive and/or the Solid Fuel Association?	Please choose... Yes No
We presume that by filling in this form you are happy for us to use the content of this form to create an anonymised survey, (e.g. depending on responses, we might say we have had 100 responses and 50 of them were happy with their experiences, 25 were unhappy and 25 state that they were made very ill).
Enter Security Code:
Thank you very much indeed for completing this form. Your help is much appreciated and may well save lives.