ALL COUNTIES SCAFFOLDING

Name:

Address:

Company Name (if applicable):

Tel No:

Email:

Skype Name:

Description of Scaffold Required:

Choose Required Scaffold Here New Extension Maintenance (e.g. re-roof, re-render, re-point or painting) Commercial Premises Industrial Buildings New Building Housing Demolition Public Events Other (please describe in the text box below)

If you have chosen other please describe here:

Dimensions:

Length:       Width:       Height:   

Period of Hire:

Weeks:   

Access and Permissions:

* Are there any overhead electric cables within 30 meters of the works area: Yes:   No: 

* Are the works adjacent to or over any form of waterways: Yes:   No: 

*Are the works adjacent to or on public footpaths or highways. Yes:   No:    If yes then a licence may be required.

*Are there any other considerations for the health and safety of the work force or the effect that they may have on others. Yes:   No: 

If you have answered Yes to the above question, please explain here:

*Please be aware that all quotes are subject to written confirmation.