Request for Service.

Please complete this form to get a free assessment for your building. In order to prepare a quote a site visit may be required.

The fields with an orange dot are compulsory.

Building

Status

request for service

Building Name

Physical Address

Suburb or RD

Town

please select Masterton Carterton Greytown Featherston Martinborough Castlepoint Eketahuna Gladstone Mauriceville Mt Bruce Pirinoa Riversdale Tinui Wainuioru

Building Consent Authority

please select Masterton District Council Carterton District Council South Wairarapa District Council

Type of Fire alarm

please select Type A/B Type 2 or higher None Unknown

Schedule kept at

Height of detector(s)

please select heigher than 3 m lower than 3 m none

Current Warrant of Fitness?

please select

yes

no

WOF next due (if applicable)

Owner / Owner's Representative

please select Mr Mrs Miss Ms none

Contactperson First Name(s)

Contactperson Last name

Name of owner

Address

Suburb or RD

Town

Phone

Who undertakes owners checks?

please select Owner Tenant Premier Design

Contracting party

please select Owner Tenant

Tenant (If applicable)

Mr Mrs Miss Ms none

First Name(s)

Last name

Address

Suburb or RD

Town

Phone

Email

Email address for checks

Billing address

Address

Same as owner

Same as tenant

Other (please fill out below)

Billing to the attention of

Address

Suburb or RD

Town

Comments