Home Cover Inspection Request Form

Home Cover - Inspection Request

I am interested in participating in the Fords Home Cover scheme.

Full Name (*)

Please type your full name.

Address (*)

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Postcode (*)

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Telephone number (*)

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Date Boiler was last serviced?

Please select a date when we should contact you.

Email address (*)

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Would you like to receive service communication via email?
Yes please
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Please select the level of service you are interested in? (*)
Gold
Silver
Plumbing
Electrics
Home Care Electrical Installation
Don't know

Please select the level of service you are interested in

I understand that the system must be inspected for suitability and I would like you to contact me to make an appointment. (*)
I agree
You must agree to an inspection

I understand, once accepted onto the home cover scheme, that my monthly payment will be in advance and I will pay monthly by direct debit. (*)
I agree
If accepted onto the scheme you must agree to paying by direct debit.

Once this form is submitted, you will be contacted to discuss your current heating system and an appointment will be arranged for an inspection of the systems requiring cover.