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Personal Information
Full Name
*
Contact Number
*
Email Address
*
Property Information
(for assessment)
Property Type
*
-- Select --
Bungalow
Flat
Maisonette
House
Number of bedrooms
*
1
2
3
4
5
10+
6
7
8
9
10
Condition
*
-- Select --
Furnished
Unfurnished
Storeys
*
-- Select --
1
2
3
4
Reason for Order
*
For Sale
For Rent
Other Reason
Number of fuse boards (EICR)
(10 circuits per fuse board - additional costs apply for more)
1
2
3
4
5
6
Number of appliances (PAT)
1
2
3
4
5
6
7
8
9
10+
Number of appliances (<%selectedGasServiceStr%>)
1
2
3
4
5
Floor area (approx)
*
-- Select --
50
100
150
200
250
300
350
400
450
500
550
600
650
700
750
800
850
900
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1000
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2150
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2500
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2800
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7000
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7250
7300
7350
7400
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7500
7550
7600
7650
7700
7750
7800
7850
7900
7950
8000
8050
8100
8150
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8250
8300
8350
8400
8450
8500
8550
8600
8650
8700
8750
8800
8850
8900
8950
9000
9050
9100
9150
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9250
9300
9350
9400
9450
9500
9550
9600
9650
9700
9750
9800
9850
9900
9950
10000
10050
10100
10150
10200
10250
10300
10350
10400
10450
10500
10550
10600
10650
10700
10750
10800
10850
10900
10950
11000
11050
11100
11150
11200
11250
11300
11350
11400
11450
11500
11550
11600
11650
11700
11750
11800
11850
11900
11950
12000
12050
12100
12150
12200
12250
12300
12350
12400
12450
12500
12550
12600
12650
12700
12750
12800
12850
12900
12950
13000
13050
13100
13150
13200
13250
13300
13350
13400
13450
13500
13550
13600
13650
13700
13750
13800
13850
13900
13950
14000
Over 15000
-- Select --
sq metres
sq ft
Property Type
Contact For
-- Select --
Me
Seller
Tenant
Landlord
Agent
Other
<%order.otherInfo.contactforaccess%> Name
<%order.otherInfo.contactforaccess%> Contact Number
<%order.otherInfo.contactforaccess%> Email
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