ENQUIRY FORM
Are you a council or housing association tenant?
Yes
No
Have you reported one or more of the following issues to your landlord in the last 6 months:
Active leaks
Cracks/structural damage
Roof issues
Severe mould (affecting multiple rooms)
Heating issues
Electrics issues
Subsidence
Infestation (Rats/Insects)
Asbestos
Other
Has your landlord rectified the issues?
Yes
No
Approximately how long ago did you first report the issue to the landlord?
Over 1 year ago
6-12 months
Under 6 months
SORRY YOU ARE NOT ELIGIBLE AT THIS TIME!
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Customer Details:
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: 00000 000000.
E-mail
example@example.com
How did you hear about us?
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Newspaper
Internet
Magazine
Other
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