Survey Request Form

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If you are interested in the Daikin Altherma air-to-water heat pump system, supplied by Space Air for your central heating system, then please complete the form below and we will contact you so you know what the next course of action will be.

Note: Your privacy is important to us. Any and all information you supply will only be used for the purposes stated.

All fields marked with a ∗ are mandatory.

Name and Contact Details

Title MrMrsMsMissRevDr Forename* Surname* Company name Contact telephone Email* Address   Town County   Bedfordshire       Berkshire       Bristol       Buckinghamshire       Cambridgeshire       Cheshire       City of London       Cornwall       Cumbria       Derbyshire       Devon       Dorset       Durham       East Riding of Yorkshire       East Sussex       Essex       Gloucestershire       Greater London       Greater Manchester       Hampshire       Herefordshire       Hertfordshire       Isle of Wight       Kent       Lancashire       Leicestershire       Lincolnshire       Merseyside       Norfolk       North Yorkshire       Northamptonshire       Northumberland       Nottinghamshire       Oxfordshire       Rutland       Shropshire       Somerset       South Yorkshire       Staffordshire       Suffolk       Surrey       Tyne and Wear       Warwickshire       West Midlands       West Sussex       West Yorkshire       Wiltshire       Worcestershire               Aberdeenshire       Angus       Argyllshire       Ayrshire       Banffshire       Berwickshire       Buteshire       Cromartyshire       Caithness       Clackmannanshire       Dumfriesshire       Dunbartonshire       East Lothian       Fife       Inverness-shire       Kincardineshire       Kinross       Kirkcudbrightshire       Lanarkshire       Midlothian       Morayshire       Nairnshire       Orkney       Peeblesshire       Perthshire       Renfrewshire       Ross-shire       Roxburghshire       Selkirkshire       Shetland       Stirlingshire       Sutherland       West Lothian       Wigtownshire               Anglesey       Brecknockshire       Caernarfonshire       Carmarthenshire       Cardiganshire       Denbighshire       Flintshire       Glamorgan       Merioneth       Monmouthshire       Montgomeryshire       Pembrokeshire       Radnorshire               Antrim       Armagh       Down       Fermanagh       Londonderry       Tyrone    Postcode*

Property address

Address   Town County   Bedfordshire       Berkshire       Bristol       Buckinghamshire       Cambridgeshire       Cheshire       City of London       Cornwall       Cumbria       Derbyshire       Devon       Dorset       Durham       East Riding of Yorkshire       East Sussex       Essex       Gloucestershire       Greater London       Greater Manchester       Hampshire       Herefordshire       Hertfordshire       Isle of Wight       Kent       Lancashire       Leicestershire       Lincolnshire       Merseyside       Norfolk       North Yorkshire       Northamptonshire       Northumberland       Nottinghamshire       Oxfordshire       Rutland       Shropshire       Somerset       South Yorkshire       Staffordshire       Suffolk       Surrey       Tyne and Wear       Warwickshire       West Midlands       West Sussex       West Yorkshire       Wiltshire       Worcestershire               Aberdeenshire       Angus       Argyllshire       Ayrshire       Banffshire       Berwickshire       Buteshire       Cromartyshire       Caithness       Clackmannanshire       Dumfriesshire       Dunbartonshire       East Lothian       Fife       Inverness-shire       Kincardineshire       Kinross       Kirkcudbrightshire       Lanarkshire       Midlothian       Morayshire       Nairnshire       Orkney       Peeblesshire       Perthshire       Renfrewshire       Ross-shire       Roxburghshire       Selkirkshire       Shetland       Stirlingshire       Sutherland       West Lothian       Wigtownshire               Anglesey       Brecknockshire       Caernarfonshire       Carmarthenshire       Cardiganshire       Denbighshire       Flintshire       Glamorgan       Merioneth       Monmouthshire       Montgomeryshire       Pembrokeshire       Radnorshire               Antrim       Armagh       Down       Fermanagh       Londonderry       Tyrone    Postcode*

General property details

Property type* TerracedSemi-detachedDetachedFlat/apartmentBungalowCommercial Approximate area Height -select a unit-metresfoot Width -select a unit-metresfoot Depth -select a unit-metresfoot Year built Number of floors* Main electrical supply Single phaseThree phasesDon't know Do you have a conservatory?

Yes No

Glazing SingleDoubleOther Number of bedrooms* Number of bathrooms*

Property details » Roof

Do you have roof insulation?

Yes No

Roof insulation thickness 50100150200250

Property details » Walls

Wall 1 insulation Interior wallBrick cavityInsulated brick cavity105mm solid brick220mm solid brickWood frameSpecify U Wall 2 insulation Interior wallBrick cavityInsulated brick cavity105mm solid brick220mm solid brickWood frameSpecify U Wall 3 insulation Interior wallBrick cavityInsulated brick cavity105mm solid brick220mm solid brickWood frameSpecify U Wall 4 insulation Interior wallBrick cavityInsulated brick cavity105mm solid brick220mm solid brickWood frameSpecify U

Property details » Windows

Number of single glazing windows Number of double glazing windows Number of other windows

Property details » Doors

Number of outside/patio doors Area of patio doors

Ownership

How long have you lived in the property (in years)? Do you own the property?

Yes No

Do you have any restrictions?

Yes No

How many people live in the property?

 

If you do not own the property or there are any restrictions from local authorities, we strongly recommend that you obtain the necessary permissions prior to survey.

Heating Details

Existing heating system* GasOilLPGElectricNone Heating system age (in years) Heating system location KitchenGarageBathroomUtilityBedroomAiring cupboardNone Boiler type* CondensingCombiConvectional Boiler size Hot water storage tank 0100L150gL300LN/A Water tank location KitchenGarageBathroomUtilityBedroomAiring cupboardNone Airing cupbard size Do you have radiators?

Yes No

Radiator type SingleDoubleMixed Number of radiators Underfloor heating?

Yes No

Reason for changing Save moneySave energyExtension Any other info