Customer Details:
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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E-mail
example@example.com
How did you hear about us?
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Facebook
Facebook Community Page
Facebook Post
Facebook Ads
Instagram
Website
Google
Internet
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Other
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Name of referral
Brief description of works required. If double story, please state if up or downstairs.
Dwelling Type
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Single Story
Double Story
Is there a manhole to access roof?
Yes
No
Roof Type
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Pitched
Flat
Roof Material
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Tiled
Colorbond
Does your Switchboard have Safety Switches (RCDs) installed>
Yes
No
Unsure
Photos of existing powerpoints or light switches if required so we can match existing.
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Any other supporting photos of locations, fittings etc to help us better understand your required works.
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