Request a service

Which service would you like to request?
Are you requesting a service on behalf of someone else?
- Yes
- No
Your name * REQUIRED
First Last
Your address * REQUIRED
Please put the building number followed by the flat number if address is a flat.

Street Address Address Line 2 City Postcode
You email address * REQUIRED
Your phone number * REQUIRED
Do you have permission from the person requiring the service to order on their behalf? * REQUIRED
- Yes
- No
You must have the permission of the person requiring the service to place an order
Client details
Client name * REQUIRED
First Last
Client address * REQUIRED
Please put the building number followed by the flat number if address is a flat.

Street Address Address Line 2 City Postcode
Housing status * REQUIRED
Please select Housing Association
Client phone number * REQUIRED
So we can contact you.
Client email address * REQUIRED
So we can email you to confirm your service request.
Client date of birth - must be dd/mm/yyyy format * REQUIRED
So we can assess eligibility only
DD slash MM slash YYYY
Anything else you can tell us about the job?
Description of work (Please provide as much detail as possible)
How did you hear about our services? * REQUIRED
Please select materials required (if known)
- Exitex door brushes
- Standard size door sets
- Internal letterbox covers with the brush strips built in
- Other
Name
This field is for validation purposes and should be left unchanged.

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Client details