Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
Untitled Page
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Property Details
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Q1.1. Work element: [Planned Works: Scope of work]
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Q1.2. Address: [Planned Works: Full address (one line)]
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Q1.3. Resident Name
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[Planned Works: Resident's full name]
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Kitchen Survey
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Q2.1. How many bedrooms in property
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Q2.2. Fuse board location
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Q2.3. Stop cock location
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Q2.4. Gas meter location (if applicable)
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Q2.5. Any existing appliances not to be included in plan
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Q2.6. Any new appliances that will be purchased prior to kitchen replacement
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Q2.7. Any further comments or notes
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Q2.8. Photos
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Q2.9. Extractor Fan Position
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Q2.9.1. Please State
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Q2.9.2. Is one required, if so state where it will be positioned
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Q2.10. Additional works agreed by client:
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Kitchen Choices
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Please select one of the following options:
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Doors:
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- SENATOR NATIVE OAK
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- SENATOR GREY ASH
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- SENATOR WHITE GRAINED
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- SENATOR CASHMERE GRAINED
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- SENATOR GREY GRAINED
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- PATINA LIGHT GREY GLOSS
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- PATINA WHITE GLOSS
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Worktops:
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- BEIGE GRANITE
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- MIDNIGHT GRANITE
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mdgroup
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COMAR OAK
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TECTONICA
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MARMO BIANCO
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HANDLE CHOICES:
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CHUNKY D HANDLE
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T-BAR
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SATIN D
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TAPER
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Tile Options:
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White gloss
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Light Grey Gloss
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Grey Gloss
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Mid Grey Gloss
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- type: Wall Colour
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text: Please select one of the following paint options
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text: White
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text: Magnolia
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- text: Not Answered
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Q3.6. Flooring Please select one of the following options Autumn Beige (4140) Ash Grey (4540) Silver Birch (4020) Black Walnut (4150)
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Not Answered
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Q3.7. Resident Signature Please note that once signed to confirm your selections there will be a 7-day cooling off period, after this time order will be placed with suppliers and we will be unable to make any changes. All colours are approximate reproductions only. Please see samples for actual colour. Signature Name Date No Signature
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4. Disclaimers
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Q4.1. Item Disclaimer No
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Q4.1.1. I confirm that I do/do not require the following Not Answered
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Q4.1.1.1. Please provide further information Not Answered
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Q4.1.1.2. Please provide further information Not Answered
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Q4.2. Removal Disclaimer The responsibility for the removal of household & personal items to facilitate works to my home is that of the householder. Should I request a worker representing MD Group to move any item for me, I accept full responsibility for any damage that may occur and understand that I can not make a claim regarding this.
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Q4.3. As resident of the mentioned property, I sign with full knowledge and consent to above disclaimers Signature Name Date No Signature
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Form completed by
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Resident Liaison Officer Signature
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Signature
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Name
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Date
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No Signature
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Location stamp
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Longitude
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Latitude
