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Your Name:   Address: Contact Telephone: E-mail Address: Postcode: Details of work required: (e.g. House rewire/ Pat Testing/ Bathroom light etc). Only complete the following questions if you require a home rewiring: 1. Type of home?   Detached Semi detached Bungalow Terrace/Town Flat Other   2. Number of Rooms in home: (including kitchen, bathroom, hall & landing etc)? n/a 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20   3. How many fuses in your old fuse box (to give an idea of the amount of circuits)? n/a 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15       4. How many lights are needed? 5. How many sockets are needed?   n/a 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41+ n/a 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41+       6. Do you have or want power to a shower?   No Yes   Form Anti Spam Validation Please enter text exactly as in image above