Heating Maintenance
Contract Renewal & Application
153678
YOUR DETAILS
Title
Initial
Surname
Email
Customer Ref:
Address
Postcode
Telephone Home
Telephone Work
Mobile
Type of boiler, make &
model
Approx. age of boiler
Date
Signature
Please tick option required
Option 1 Plan S 
Option 2 Plan B 
Option 3 Plan C 
£120.00 (inc VAT) per annum or £10.66 per month
£143.04 (inc VAT) per annum or £12.59 per month
£186.00 (inc VAT) per annum or £16.16 per month
On receipt and acceptance of your advanced payment of standing order mandate, we will plan your service allowing for demand and entry
arrangements, and endeavour to complete this during the summer months. If you cancel your agreement before sufficient payment has
been made you agree to pay MG Heating the cost of any service completed. Please see terms and conditions and exclusions.
Please return your completed form to MG HEATING, 1-2 BERNARD WAY, NEWPORT, ISLE OF WIGHT, P030 5YL
PAYMENT CHOICES
PAYMENT CHOICE 1 Payment by Cheque – Annual Payment
Your cheque for £ ………………….. should be made payable to MG Heating. Please write your name
and address on the back. Return with completed application form to MG Heating.
PAYMENT CHOICE 2 Payment by Credit Card / Debit Card – Annual Payment
VISA 
MASTERCARD 
SWITCH 
DELTA 
Issue No …………………………
Name of Account Holder …………………………………………………………………………
Card No……………………………………………………………………………………………………
Expiry Date …………………………………………….
Security Code…………………………………………
PAYMENT CHOICE 3 Payment by Standing Order – Monthly Payment
Instruction to your Bank or Building Society to pay by Standing Order
Please pay to MG Heating Sort Code 30-95-99 Account No 40040268 Twelve equal monthly
payments of £ ……………………. Commencing on ……………………………..
Please fill in the form using a ballpoint pen and send it to:
MG Heating, 1-2 Bernard Way, Newport, IW, P030 5YL
To the manager
Bank/Building Society
Address
Branch Sort Code
Bank/Building Society Account Number
Signature
Date