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
Date Format: 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
Comments
This field is for validation purposes and should be left unchanged.

Client details