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Name
Email
Phone
Date of ruubish removal
What time do you want us to arrive for your rubbish?
What time do you want us to collect your rubbish by?
Address
Post code
Where is it from
House
Flat
Office
Do you have private parking?
Yes
No
Parking restriction outside
How much rubbish do you estimate there will be on the van?
less than ¼ of the van
more than ¼ but less than 1/3 of the van
more than 1/3 but less than ½ of the van
more than ½ but less than ¾ of the van
more than ¾ but less than full load
full load
Parking restriction outside