Report your repair:

Full Name:
Address 1:
Town/City:
Post Code:
Tel (Home):
Tel (Work):
Tel (Mobile):
e-mail addr:

Please describe the problem. Remember to be as specific as possible
e.g. slight leak on pipe that goes from a cistern to toilet pan.

Please indicate where the repair is e.g. downstairs toilet.

Please indicate which days of week may suit you and preferred
time slot (morning or afternoon).

Note: Your repair will get fixed based on its priority level
which will be determined when we recieve this form

Have you reported the same repair before? Yes: No:
If yes, please give details:

Is the fault due a vandalism? Yes: No:
If yes, what is Crime Ref Number:
Note: We need the Crime Ref to carry out a repair resulting from a vandalism.
We cannot carry out the repair unless this is included.

Personal information supplied by you will be held and used in accordance with the Data Protection Act 1998.