Order confirmation

Name of customer(Required)

First Last

Email(Required)

Telephone number(Required)

Address of customer:(Required)

Treatment address (if different from home address)(Required)

Please proceed with remedial work in accordance with your quotation dated(Required)

Value of the work + VAT(Required)

Preferred commencement date(Required)

Confirm you have read our 'Information, terms and conditions'(Required)

Yes

Date