Recycle request form
Name of our contact person
First name
Last name
E-mail of our contact person
*
This e-mail will be used for further comunication
Details of collection at the original address
Was the piano purchased from us?
*
Yes
No
If so, do you know your customer number ?
Earliest moving date
-
Maand
-
Dag
Jaar
Datum
Latest moving date
-
Maand
-
Dag
Jaar
Datum
Piano brand
*
Type?
*
Grand piano
Upright piano
Height (in cm)
*
If upright piano
Length (in cm)
*
If grand piano
Please add a clear picture of your instrument
*
Door Bestanden Bladeren
Drag and drop files here
Choose a file
Cancel
of
Collection contact
*
Name + mobile number
Collection adress
*
Street
House number
Postal code
City
Province
Where is your piano
Ground floor
First floor
Second floor or heigher
Are there any obstacles?
*
For example: stairs, narrow passage, unpaved driveway, grass...
If not on ground floor, can the piano be moved outside through a window on the street side?
Photos of the situation
*
Door Bestanden Bladeren
Drag and drop files here
Choose a file
Cancel
of
Please forsee a free parking space of
at least 17 metres
Invoice address
*
name - address - postal code - city
VAT number
E-mail where we should send the invoice to
*
SEND
Should be Empty: