Name:

Surname:

Email Address:

Telephone No.:

Cell/Mobile No.:

Town/Suburb:

No. of persons living in the house

Select a number 1 2 3 4 5 6 6+

No. of geysers in the house

Select a number 1 2 3 4 4+

Pitch of roof

Select One flat 10-30 30-45

Roof type

Select One cement tiles flat asbestos tiles tile slate stell corr. IBR fibre cement sheets other

Does your roof face?

Select One North NW West NE East

Comment / Query