*Name:       * denotes required field

Address 1: 
Address 2: 
Town:         
County:      
Postcode:  

Phone Number:      Mobile Number:  

*e-mail address:    

Room length    

Room width      
[Note - please measure to widest points ie into door recess etc]

Room Location - Please choose option: Lounge Hall / Stairs / Landing Dining Room Bedroom Play Room / Family Room Kitchen Bathroom Other (please state in comments box below)

Manufacturer - Please choose option: Armstrong Axminster Brintons Brockways Causeway Cormar Carpets of Worth E and WE (EWE) Gaskell Wool Rich Georgian Goodacre Gradus Halstead J.L.W. Karndean Manx Penthouse Nairn Pownalls Ryalux / W Lomas Telenzo Tintawn Westex Woodward Grosvenor

Range - Please state choice:

Do you require underlay? Please choose: No Duralay Hallmark Supreme £5.95/sq yd, £7.11/sq m Scottdell Highlander £3.95/sq yd, £4.72/sq m

Type of subfloor? Wood Concrete

Fitting required? Yes No

Doorplates required? Yes No

Room cleared or require clearance? Room clear Require clearance

Special Requirements / Comments:

Thank You

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