NLCE – Property Fault Report – Completed Maintenance issue

Oct 27th, 2016

Your Name*
First Last
Your Email Address*
Your Telephone Number*
Drop-in Session Date (1st choice)*
Please enter your ideal 'drop-in session' date here.
Date Format: DD slash MM slash YYYY
Drop-in Session Time (1st choice)*
Please enter your ideal 'drop-in session' time here.

: HH

MM
Drop-in Session Date (2nd choice)*
Please enter your next available date here, should your 1st choice be unavailable.
Date Format: DD slash MM slash YYYY
Drop-in Session Time (2nd choice)*

: HH

MM
Drop-in Session Date (3rd choice)*
Date Format: DD slash MM slash YYYY

Please enter your next available date here, should your 1st & 2nd choice be unavailable.
Drop-in Session Time (3rd choice)*

: HH

MM
Digital Signature*
- I confirm I understand that I will be billed £15.00 per one hour session and it will take place at 5 St Margarets Terrace, WSM, BS23 1AH.
Once you have clicked this box and submitted the form to us we will be in contact ASAP to confirm your 'drop-in session' date and payment options.

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