Request for Service

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To complete the booking process we require some additional information from you. Please complete the details below and submit.

Between 7:00 am and midnight one of our consultants will contact you within 60 minutes by phone to finalise your appointment request. Outside of these hours you will be contacted by 9:00 am the next day. Please try and supply a number that we will be able to get hold of you on within the next hour e.g. a mobile telephone if you have one or your work number if you are at work. All fields marked with an asterisk (*) are mandatory.

Customer Details
Business name*
Have Account
Account Number
Salutation
First Name*
Last Name*
Position
Business Address
Street No*
Address*
Suburb*
Postcode
Phone*
Mobile
Email
Job Details
Site Contact First Name
Site Contact Last Name
Date You Would Like It Fixed
Preferred Time
Phone
Mobile
Street No
Address
Suburb
Postcode
Description Of Work To Be Done
Insurance details
Cause of Damage
Insurance company/broker
Policy Number
Expiry Date
Authorisation Number (Smith & Smith® to complete)
Excess Amount
Product Details
Usage
Quantity
Height
Width
Additional Comments
Privacy Policy and Legal Notices	The personal information you give us will be used by Smith & Smith® to provide the service you have requested and as set out in our Privacy Policy. We may use it to send you marketing messages (by mail, email and telephone) about related services which may be of interest to you. If you do NOT wish to be sent marketing messages please tick the box: By clicking 'Submit' you confirm that you have read and agree to the terms of our Privacy Policy and our Legal Notices. Unless you have ticked the appropriate box above to decline, by clicking 'Submit' you are also consenting to receive marketing messages (by mail, email and telephone) about related services which may be of interest to you.

Contact us

Call us FREE on 0800 80 45 27

You can also contact us via email.