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    Type of Appointment*Please select one of the options.
    Installation quotation
    Inspection for LP Gas COC
    Appliance fault identification
    Appliance and gas supply installation
    Appliance Installation
    Gas supply installation
    Service of an installation or appliance
    Repair of installation or appliance

    Appliance/s to be installed

    If you have already purchased the appliance/s, please provide the information as best possible?

    1. Appliance
    1. Appliance Make and Model
    1. Appliance Serial Number
    2. Appliance
    2. Appliance Make and Model
    2. Appliance Serial Number
    3. Appliance
    3. Appliance Make and Model
    3. Appliance Serial Number

    Appliance/s and gas supply to be installed

    If you have already purchased the appliance/s, please provide the information as best possible?

    1. Appliance
    1. Appliance Make and Model
    1. Appliance Serial Number
    2. Appliance
    2. Appliance Make and Model
    2. Appliance Serial Number
    3. Appliance
    3. Appliance Make and Model
    3. Appliance Serial Number

    Appliance/s Faulty

    Please provide the information as best possible?

    1. Faulty Appliance
    1. Faulty Appliance Make
    1. Faulty Appliance Serial No.
    2. Faulty Appliance
    2. Faulty Appliance Make
    2. Faulty Appliance Serial No.
    3. Faulty Appliance
    3. Faulty Appliance Make
    3. Faulty Appliance Serial No.

    Appliance/s to be serveced

    Please provide the information as best possible of the appliances to be serviced?

    1. Service Appliance
    1. Service Appliance Make and Model
    2. Service Appliance
    2. Service Appliance Make and Model
    3. Service Appliance
    3. Service Appliance Make and Model

    Appliance/s Repair

    Please provide the information as best possible of the appliance/s to be repaired?

    1. Repair Appliance
    1. Repair Appliance Make and Model
    2. Repair Appliance
    2. Repair Appliance Make and Model
    3. Repair Appliance
    3. Repair Appliance Make and Model
    Preferred Appointment Date *
    Time *
    Alternate Date for Appointment
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    Message *
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    I have read and agree to the Terms and Conditions

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