[] 1 Your Details Personal Details Customer Name0 / Full Address and Postcode0 / Customer Phone Number0 / Customer EmailIf none please type N/A0 / Services Required Service RequiredSelect An OptionStandard Sweeping (Stoves and open fires) - £125 per flueStandard Sweeping (Gas fires) - £125 per flueNew Homeowner Inspection - £250 per fluePre-Install Sweep & CCTV Inspection £225 per flueChimney Leakage Test - £350 per flueBird/Wildlife Removal & Sweep - £150 per flueBird Nest Removal - £350 per flueWoodburner/Stove Removal & Disposal (Quoted separately)Full Chimney Inspection / Party Wall Report (Quoted separately)Possible Recoheat Install - Initial Sweep & CCTV Inspection (Quoted separately)Other (please specify below) Number of Chimneys To Be SweptSelect An Option123455 + Type of FireplaceSelect An OptionStove/WoodburnerSmall Open FireLarge Dog Grate/Metal Basket Open FireNo fire fitted - Just A Hole In The Chimney BreastOpen Gas Fire Mix of Open Fires and StovesOil BoilerSolid Fuel Boiler Preferred Days For An Appointment (We are closed at weekends)MondaysTuesdaysWednesdaysThursdaysFridaysAny Day Customer Availability Days They Are NOT AvailableN/A - I'm Available Any WeekdayNot Available MondaysNot Available TuedaysNot Available WednesdaysNot Available ThursdaysNot Available Fridays Do They Need To Avoid Appointments Around 'School Run' Times?Select An OptionNoYes - AM only each dayYes - PM Only each dayYes - AM and PM each dayOnly Certain Days (Please Advise Below) Specific Dates To Avoid Within The Next 30 Days (If none please state N/A)0 / Now ask the customer what dates they are happy to be AUTOMATICALLY given an appointment (please fill in as many as possible) The 1st Date They Are Available To Have An Appointment AUTOMATICALLY Allocated To Themdate_range 1st Date - Time Slots7am-7.30am8am-noon11am-2pmNoon-5pmAny The 2nd Date They Are Available To Have An Appointment AUTOMATICALLY Allocated To Themdate_range 2nd Date - Time Slots7am-7.30am8am-noon11am-2pmNoon-5pmAny The 3rd Date They Are Available To Have An Appointment AUTOMATICALLY Allocated To Themdate_range 3rd Date - Time Slots7am-7.30am8am-noon11am-2pmNoon-5pmAny The 4th Date They Are Available To Have An Appointment AUTOMATICALLY Allocated To Themdate_range 4th Date - Time Slots7am-7.30am8am-noon11am-2pmNoon-5pmAny Extra Information Which May Be Revelant Any further relevant information/specialist requests (new bricks/rope seals etc)0 / Declaration I confirm I have double checked spellings of names, addresses, phone numbers and email addresses.Confirmed Your Name (Name of Call Handler)0 / Submit keyboard_arrow_leftPrevious Nextkeyboard_arrow_right FormCraft - WordPress form builder