New Client Information Form
Please complete all sections and read the Terms and Conditions of Trade overleaf or attached.This is a Client Information Form under the Construction Contracts Act 2002.
Full or Legal Name*
First Name Last Name
Physical Address:
Billing Address: (if different to Physical)
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code
Phone Number:*
Email*
Date of Birth:*
Day Month Year
Date
Driver's Licence No:*
I certify that the above information is true and correct and that I accept the supply of credit by the Contractor (if applicable). I have read and understand the TERMS AND CONDITIONS OF TRADE (overleaf or attached) of Manawatu Plumbing & Maintenance Limited T/A Laser Plumbing Manawatu which form part of, and are intended to be read in conjunction with this Client Information Form and agree to be bound by these conditions. I authorize the use of my personal information as detailed in the Privacy Act clause therein.
Signature*
Clear
Date*
Month Day Year
Date
Please give us a short description of what is required to be quoted:
Please upload a picture of the area
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What is your budget to spend?*
Do you have a specific date you want this job completed?*
Month Day Year
Date
Please rate how easy this form was to complete
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New Client Information Form