Synergy Contract Enquiry Form

Please note that this form does not constitute any agreement, it is designed to help assess an application for the Synergy Contract scheme only.
The "Owner" and financer will be a finance company called Shire Leasing which is entirely separate from the Synergy Grill.
* Must be completed.

Section 1 - About you

Full Name *

Business Name *

Business Address *

Postcode *

Email *

Phone

Business Type *

VAT Number (If applicable)

Company Registration number or Charity number (If applicable)

Number of years, business has been trading *

Home Address (If Sole Trader)

How did you hear about Synergy Grill?

If through one of the Synergy Grill Partners, what is their partner code?

Section 2 - About your new Synergy Grill

What grill do you require *

Do you need any accessories? *

Accessories

Would you require a stand? *

If no, what are you placing the grill on?

Do you require Natural Gas, LPG or Electric? *

Do you have an old grill that needs to be removed? (Maximum Size we can remove is 1704mm x 540mm x 705mm) *

Section 3 - About removing your old equipment

Location of existing unit (e.g. main kitchen, 3rd floor pantry etc):

Same location for new install? If not, new install location:

Existing item make:

Existing item model:

Existing item dimensions (WxDxH):

Is existing unit part of a suite?

Is existing item gas (LPG or NG) or electric?

Section 4 - About installing your new Synergy Grill

Do you require the free installation of your new grill? *

Is new installation point completely under canopy?

If ordering an electric grill do you have 3 phase 16amp power supply?

Is the gas supply size available at location of install correct? (i.e. ¾” iron)?

Is the gas supply bayonet within 1.5M of installation point?

Is electrical 13 amp supply available within 1.5 metres of grill install location?

Does installation have sufficient permanent Make Up Air?

Is Installation interlocked and working (not bypassed)?

Section 5 - Access

Please advise MAX space available for new unit (WxDxH):

Floor of Installation (e.g. 2nd floor):

How many flights of stairs to manoeuvre equipment:

Lift available?

Number of doorways to manoeuvre through:

Number of turns while manoeuvring equipment:

Times to avoid/access restrictions:

Is parking available on site?

If no, details of nearest parking and costs:

Section 6 - Other information

Is there any further information you feel would be useful for our engineers to know about the installation?

If yes, please write here

Terms & Conditions *

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