Customers Name
Title
Mr
Mrs
Ms
Miss
Initial
S
urname
Customers Address
Post Code
Delivery Address
Tick box if same address as above
Delivery Address
If Different
Post Code
Contact Telephone No.
inc. STD Code
Mobile
E-mail
Type of Skip Required
2 Tonne Mini (3 Day Hire)
4 Tonne Midi (3 Day Hire)
8 Tonne Builders Skip (7 Day Hire)
Roll on off 16³yds/15³M (7 Day Hire)
Roll on off 30³yds/³M (7 Day Hire)
Extended hire £2 per day on all containers
Brief Description
of Waste
Date Required
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
2007
2008
2009
2010
Where is
skip to be dropped?
Please Select
Drive
Road
Other
If other please state where
I have read and accept the conditions of hire.
No
Yes
