Personal details First name Last name Address Address City Postcode What device are you claiming a refund for? What device are you claiming a refund for? Heater Dehumidifier Do you know the date range the devices were used for? Yes No Dates Date device was provided Date issue was fixed How many devices were you given? How many devices were you given? Refund details Name on account Account Number Sort Code Name of bank We will need to contact you via telephone to verify the details given above. Please provide us with your telephone number and when would be best to contact you. Contact details Telephone number When should we contact you? Monday AM Tuesday AM Wednesday AM Thursday AM Friday AM Monday PM Tuesday PM Wednesday PM Thursday PM Friday PM Leave this field blank