| Customer number | |
| Name: | |
| I.D number | |
| E-mail address | |
| Telephone number: Res/work | |
| Mobile | |
| Service Location Address | |
| Building Name | |
| Flat/Shop | |
| Postal Code | |
| Number of Persons living at the building | |
| Type of premises: |
Residence Restaurant Industry Hotel Other |
| Mailing address(if different from above) | |
| Building name | |
| Flat Shop | |
| Postal Code | |
| P.O.Box | |
| Postal code | |
| Comments and suggestions | |