Site Survey Form	Acantha Lifestyle Products
Contact Details Please provide the following contact information (** Required): Name** Address Address (cont.) Town Post Code Telephone** FAX E-mail** Survey Details 1.) Has the chimney been swept by an approved NACS Sweep? Yes No Other 2.) Are Pots ok? Or is there Liner in the Chimney? Yes No Other 3.) What type of fire required? 4.) Is there already a provision for gas? Yes No Other 5.) Is the gas supply live? Yes No Other 6.) If gas run is required is the existing pipe copper / meter connection? Yes No Other 7.) Is there an existing fireplace? Yes No Other 8.) What type of property is this? 9.) What level is the fireplace to go on? 10.) Is there a working floor/wall vent fitted? Yes No Other 11.) What type of flooring is there? 12.) What floor covering is there? 13.) Is the floor covering about to be replaced? Yes No Other 14.) Is there a concrete sub-hearth in front of your opening? Yes No Other
Measurements (cm)   A = Width of breast   B = Width of opening C = Height to opening LHS D1 = Width to opening LHS D2 = Width to opening RHS E = Depth of opening F = Depth of breast G = Width of sub-hearth H = Depth of sub-hearth J = Depth of Lintel X = Existing position of gas supply
Fireplace Details Surround Shelf or Rebate Modifications Hearth Size Stone Type Insert or Basket Type Highlighting or other modification Gas Fire Type: Standard Back Panel or Slip Set Sizes Accessories
Further Comments

Thank you for taking the time to complete this form and we will endeavour to answer any enquiries or resolve any problems to your satisfaction. All orders are subject to our terms and conditions

Customer Services Department