Order form

Prefer to fill in a PDF? Download the order form (PDF) (Dutch version) and email it to info@amkoirschot.nl.

Place an order for a survey directly:

CLIENT

Contact and billing details

Name of the client (company or private individual) (required)

Contact person (required)Email for the report (required)Email for the invoice (required)Phone (required)Address (required)Postcode (required)Town (required)

PROJECT LOCATION

Details of the building to be surveyed

On-site contact person (required)Phone (required)Address (required)Postcode (required)Town (required)

Occupant (if different from the contact person)

Occupant's phone

Year of construction and known renovations

Floor area (m², approximately)

Brief description of the building

Extent (required)Type of building (required)Planned work (required)During the survey (required)

Obtain information from (former) employees, occupants or users

Yes (name and phone below)Not possibleNot applicable

From whom (name and phone)

OWNER OF THE PROJECT LOCATION

(required for the Dutch national asbestos tracking system, LAVS)

The owner is (required)

Private individualCompany (or other organisation)

Name of private individual / company (required)KvK number (required)

For a company: the 8-digit KvK (Chamber of Commerce) number.

Owner's gender (required)

MaleFemale

Phone number (required)Street (required)Postcode (required)Town (required)Agreed price (if known)

excluding 21% VAT, including travel costs; sample analysis € 25 per sample excluding VAT

Building drawings (required)

Access (required)

The client provides free access to all rooms (without any obstruction)

I agree

Terms and conditions (required)

The client agrees to the DNR 2011 terms and conditions (Dutch version).

I agree

Thank you for your order! I have received everything and will contact you to schedule an appointment. Kind regards, Joep van den Oord

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