Central Service (Wickford) Ltd

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Please Note this will send an electronic form via your internet connection.

 

Title    

First Name          Surname         

 

House Number         Flat Number         Building Name

Street Name     Town County

                        Postcode                   

                                                                    Contact Numbers

Home Telephone         Mobile Telephone

Work Telephone         Fax                      

 

Email Address   * Required

 

Unit Type          Model Number         Serial Number

Unit Manufacture      Other

Repair Type          Date of Purchase (we are required to see proof of purchase prior to commencing repair)

Dealer Purchased From

Insurance Company         Policy Number         Referral Number

 

Fault Description

 

 

Preferred day for service call              Calls are normally made between 9:30 & 17:30

 

Submitting this request does not confirm a call. we will contact you to confirm any appointment