Street Address Suburb: Postcode: Description of repair needed: Please be sure to mention the make,
model and description of the
appliance (if applicable) Authority to enter: This means that you authorize
your office or repairer to enter
the property with keys in order to
carry out the repair. Yes No

*Name: *Email Address: Street address: Suburb: Postcode: Phone Number (BH): Phone Number (AH): Phone Number (Mobile): Comments: