Breakdown Agreement.

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Account number *

Do you have an account with us?

 
Account number *

Please insert your account number below:
 
Billing details

 
Full company name: *

 
Company registration number:

 
Contact Name: *

 
Full Company Address: *

 
Postcode: *

 
Telephone: *

 
Fax:

 
Accounts invoice/statement to be received by email:

     
 
Site Details (where work is to be carried out)

 
Are the site details where work is to be carried out the same as the billing address? *


 
Full Company Name: *

 
Full Company Address: *

 
Postcode: *

 
Opening Times

 
Company brands to be covered *


 
Breakdown
Call out £200.00*** (inc first 2 hours and travel time)
Additional hours charged at £75.00 *

Please select the unit for work to be carried out

 
Please insert the number of units for work to be carried out on:

*

 
Nordair Niche Breakdown

Our Rates are £75.00 ex vat per hour. If the units have not been serviced by us within the last 12 months a £200.00 ex vat call out fee applies; this will cover the first 2 hours of labour/travel, thereafter you will be chardged £75.00 ex vat per hour.
 
Please indicate the model of the unit(s) you would like us to carry out work on: *

 
Please indicate the quantity of unit(s) you would like us to carry out work on: *

 
Please indicate the serial number on the unit(s) you would like us to carry out work on: *

 
Brief description of the problem: *

 
Have the unit(s) been purchased within the last 12 months? *


 
ERO Number (Original reference number supplied to you when ordering the equipment):

Supply if known
 
Site contact name: *

 
Site contact telephone: *

 
Is access equipment required? If yes is it to be supplied by: *

**Clients must ensure that provided lifting equipment has a validated LOLER certification.

 
If client is to provide access equipment, please specify type: *

 
What is the mounting height of the unit from the floor: (m) *

 
Are the units accessible from all sides or within an enclosed space? *

 
Is a risk assessment and method statement required? *

     
 
Site induction required? *

     
 
Induction time & location: *

 
Is adequate van parking available (if not please give details) *

 
Preferred date for the work to be carried out. *

 
Confirmation

Charges are set out as included within this agreement. An additional charge of £75.00 an hour may apply if access to the equipment is prohibited, or site delays are experienced.

We confirm the data contained within this form is accurate to the best of our knowledge. We accept that we may be liable for additional charges should the information be inaccurate.
 
Name: *

 
Date *

 
Purchase order number: *

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