Ossett - RGS Cleaning Ltd

Name of Person Placing Order *

Please give your name below

Location for Order *

Prospect

Church Street

Other – Please enter

Email for copy of form

Provide an email address for anyone that needs a copy of this form

Type of items requested

Toilet Paper

Hand Towels

Bed/Couch Rolls

Hand Soap

Hand Sanitiser

OTHER – PLEASE STATE IN ANY OTHER INFORMATION

List items required, quantities, order numbers, stock codes etc. if required.

ANY OTHER INFORMATION – STATE QUANTITES NEEDED HERE

Please use this space to provide any additional information

File Upload – Use this to upload any supporting evidence such as photo’s of products

Signature (REQUIRED) *

Signature is required.

Signature of person completing form as named above