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General Information  
Full Name:
Company Name: (if applicable)
Project Name: (if any)
Contact Number:
I am enquiring service for
Product Category Products
Flush Valve
Sensor Flush Valve
Manual Flush Valve
Manual Concealed Cistern
Sanitary Ware
Water Closet c/w Flush Valve
Water Closet c/w Cistern
Squat Pan
Urinal bowl
Sensor Faucet
LED Sensor Tap
Manual Faucet
Basin Tap/Sink Tap/Bib Tap
Self Closing Delay Action Tap/Self Closing Delay Action Sink Tap
Soap Dispenser
Sensor Soap Dispenser
Manual Soap Dispenser
Hand Dryer
Sensor Hand Dryer
Water Dispenser
Cold Water Dispenser
Hot and Cold Water Dispenser
Paper Towel Holder
LED Shower
Towel Bar and Shelving/Robe Hook/Soap Holder/Folding Shower Seat
Kitchen or Pantry Sink
Date of Service Require:
Serial no./DO no./Invoice no.:
Quantity of product failure:
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