Competent Sampler Request Form

Booking Details - Competent Sampler

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Company or Private

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Property Details (property to be sampled)

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Accessibility to sampling sites (Please note samples taken from height are considered difficult)

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Accessibility to sampling sites (Please note samples taken from height are considered difficult)

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Please contact us for a quote

Preferred Sampling Date

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Access Details

Are you the best contact for access? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Please state their details below:

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Notes:

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Health and Safety

Are you aware of any health and safety risks? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Terms and Conditions

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This includes ATNZ taking intrusive samples of building materials if necessary

Terms and Conditions

- Travel Fees: Please note some bookings may incur an additional travel fee if they are outside of our standard travel radius or if access requires key collection. See our terms and conditions for further details.

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{~ Payment_Block_Label}

{binding Group}
{binding Name} - {binding Description}{binding displayValue}
{{ Cognito.resources['payment-subtotal'] + ":" }}{binding displayValue}
{binding Name}:{binding displayValue}---
{{ Cognito.resources['payment-amount-due'] + ":" }} {binding displayValue}

Competent Sampler Request Form

{{ Cognito.resources['order-transaction-details-header'] }}

{{ Cognito.resources['order-number-label'] }}: {binding displayValue}
{{ Cognito.resources['order-date-label'] }}: {binding displayValue}
{{ Cognito.resources['order-method-label'] }}: {binding MethodReference}
{binding Group}
{binding Name} - {binding Description}{binding displayValue}
{{ Cognito.resources['payment-subtotal'] + ":" }}{binding displayValue}
{binding Name}:{binding displayValue}
{{ Cognito.resources['order-total-label'] }}: {binding displayValue}
{{ Cognito.resources['order-amount-paid'] }}:({binding displayValue})
{{ Cognito.resources['order-balance-due-label'] }}:{binding displayValue}

Competent Sampler Request Form

{{ Cognito.resources['order-transaction-details-header'] }}

{{ Cognito.resources['order-number-label'] }}: {binding displayValue}
{{ Cognito.resources['order-date-label'] }}: {binding displayValue}
{{ Cognito.resources['order-method-label'] }}: {binding MethodReference}
{binding Group}
{binding Name} - {binding Description}{binding displayValue}
{{ Cognito.resources['payment-subtotal'] + ":" }}{binding displayValue}
{binding Name}:{binding displayValue}
{{ Cognito.resources['order-total-label'] }}: {binding displayValue}
{{ Cognito.resources['order-amount-paid'] }}:({binding displayValue})
{{ Cognito.resources['order-balance-due-label'] }}:{binding displayValue}

Booking Details - Competent Sampler

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Primary Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Secondary Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Company or Private

Which one are you? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Company Name (if applicable) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Property Details (property to be sampled)

Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Number of samples to be taken for analysis {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Level of difficulty in sampling location? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Call out fee including technicians time onsite {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Call out fee including technicians time onsite {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Please contact us for a quote

Preferred Sampling Date

Date: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Access Details

Are you the best contact for access? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Please state their details below:

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Mobile {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Title (eg: tenant, real estate, plumber) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Any more details we should know.. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Notes:

Please let us know if there is anything else we should know: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Health and Safety

Are you aware of any health and safety risks? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Please provide details of the hazards: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Terms and Conditions

Yes I accept the terms and conditions {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Terms and Conditions

- Travel Fees: Please note some bookings may incur an additional travel fee if they are outside of our standard travel radius or if access requires key collection. See our terms and conditions for further details.

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