Canopy Clean Request
Venue Name
*
Business Address
*
Please include street number, name and suburb
Contact Name
*
E-mail
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: 0000 000 000.
Canopy Type?
*
Stainless Steel
Galvanised
Cleaning Requirements?
*
Faces of canopy
Behind the filters
Splashback - canopy to appliances
Splashback - canopy to floor
Ducting
Fan
Polish finish
Other - please specify in 'Additional Notes'
How many filters are in your canopy?
*
Please upload as many photos relevant to your service requirement as possible
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Approximate date of last clean
*
-
Day
-
Month
Year
Date
Timeframe of when you would like completed
*
Other Information / Additional notes
Name
*
First Name
Last Name
Signature
*
Date
-
Month
-
Day
Year
Date
Continue
Continue
Should be Empty: