Online Contract

Please download direct debit instruction below and post back to O'Neil Gas Services Click to download Direct Debit Instruction

You should receive a direct debit mandate in the post within the next few days.

To set up a Direct Debit online you must be the account holder or in the case of a business account you must be an authorised signatory and only one signature must be required on the account

If you are not able to comply with the above then please download and print a mandate and post it to us. Alternatively you can telephone us on 01292 619799 to request a paper mandate.

Click to download Direct Debit Form

Please fill in the following details. These can be found on your cheque book or bank statement

Confirmation of Direct Debit details

Name: {:25}

Sort Code: {:26}

Account Number: {:27}

Confirm details above are correct.*

Please check box to agree details entered are correct.

• Agree

You will receive confirmation of Direct Debit set up no later than 10 working days before the first payment.

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Boiler Details

(If you don’t have your appliance details available please continue with the form and we can confirm the details at later date)

Order Summary

Level of Cover Required

{:3}

Payment Details

Method:  {:23}

Customer Billing Details

First Name: {:10.3} Last name: {:10.6}
Address:    {:11.1}, {:11.2}, {:11.3}, {:11.5} 

Contact Number :  {:17} 

Email:   {:12}

Bank Details

Name: {:25}

Sort Code: {:26}

Account Number: {:27}

Boiler and Fire Details

(If you don't have your appliance details available please continue with form and we can assist you filling in this at later date) 

Date of Last Boiler Service:   {:16} 
Existing Boiler Make:  {:18}     
Boiler Model:   {:19}       
Approx Boiler Age:     {:20} 

Existing Gas Fire Make:  {:41}          
Fire Model:     {:42}      
Approx Fire Age:  {:43}    

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