Loler Request Form

LOLER Request Form

Please complete the form below and we will get back to you as soon as we can.

Name: *

How you wish to be addressed when we contact you.

Company:

Name of the company if applicable

Phone/Contact Number: *

Telephone number including Area-Code ie: (01279) 123-456 or +44 1279 123-456.

Email Address: Machine Location:

Please give us the location of the machine so we can estimate travel time to site. If you don't want to add the whole address a postcode will do.

Machine Make / Manufacturer: If Other Selected Please Enter Below:

If "Other" Selected Above Please Enter the Make Here.

Machine Model: * Machine Serial No: Machine Age:
LOLER Expire Date:

Enter the date that the last LOLER expires on. If it has already run out please enter "Expired"

Known Issues: