Gold Home CareService Club Application Form Your Details Your postcode* Postcode required! Your email address* Mobile number or email address required! Your mobile number* Mobile number or email address required! Are you an existing AC Wilgar Customer?* Yes No Please answer 'yes' or 'no'! Your first name* First name required! Your last name* Last name required! Next Next Your Boiler What is the make of your boiler?* What is the model of your boiler? Your Controller What is the make of your heating controller? What is the model of your heating controller? Your Heating System How many radiators do you have?* Number of radiators required! Do you have a hot water cylinder?* Yes No Please answer 'yes' or 'no'! Your Plumbing How many toilets do you have?* Number of toilets required! How many basins do you have?* Number of basins required! How many showers do you have?* Number of showers required! How many baths do you have?* Number of baths required! NextAdd Photos
