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

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

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