Sewer Pumping Application Form
What is your name?
What is your plot number?
Are you the owner or head of the home?
Yes
No
Approximately how big is your sewer tank?
Below 2,000 Litres
Below 5,000 Litres
Below 7,000 Litres
Below 10,000 Litres
Below 12,000 Litres
Below 15,000 Litres
I am not sure
Approximately how often do you pump out your sewer tank?
Every Month
Every 3 Months
Every 6 Months
Every 9 Months
Every 12 Months
Very Rarely
I am not sure
What option would you like to apply for?
10,000 Litre Tanker @K2,000 cash on delivery
10,000 Litre Tanker @K2,600 pay slow
15,000 Litre Tanker @K2,500 cash on delivery
15,000 Litre Tanker @K3,250 pay slow
What payback period would you like to opt into?
Cash On Delivery
1 Month Full Installement
2 Months equal installemnts
3 Months equal installemnts
If you are not paying cash on delivery, what date do you want to make the first installement?
What is your source of revenue for payment when due?
Employment Salary
Business Income
Not Sure
When would you like the tanker to come for pumping?
Where Did you hear about us from ?
Is there anything else regarding property that you need help with?
Yes
No
Maybe
If you answered yes to other help, provide the details of the other help you need.
The following section is optional. Please only populate if you would like to be contacted:
May we contact you for further clarifications or discussions if needed?
Yes
No
Maybe
How would you prefer to be contacted?
Phone
Email
Physical
Your Email:
Your Phone Number:
Submit