Closomat Palma Vita Quotation Form

Your Name*

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Company/Organisation

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Address Line 1*

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Address Line 2

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Town/City*

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Post Code*

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Telephone*

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Your Email*

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Please check one option and other fields might need to be filled in*

The installation details are as aboveThe installation address details

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Client's Name At Installation*

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Installation Address 1*

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Installation Address 2

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Installation Town/City*

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Installation Post Code*

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Contact Phone No at Installation

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Your Closomat Specification

Douche Type - please choose one option*

StandardSingle ExtendedTwin Spray Invalid Input

Toilet Seat - please choose one option*

StandardAdult SoftHorseshoe SoftJunior SoftBig John Invalid Input

Flush Type - please choose one option*

StandardTouch SensitiveProximityRemote Control Invalid Input

Plinth - please choose one option*

Not Needed25 mm50 mm75 mm100 mm Invalid Input

Infill Panel - please choose one option*

Not Needed25 mm50 mm75 mm Invalid Input

Intergrated Arms - please choose one option*

Not NeededLeft & RightLeft OnlyRight Only Invalid Input

Integrated Arms Soft Sleeves*

Not NeededOne Pair (sold as pairs) Invalid Input

Lateral Body Supports - please choose one option*

Not NeededLeft & Right Invalid Input

Lateral Body Supports - Straps*

Not NeededLap Strap Invalid Input

Installation - please choose one option*

Supply OnlySupply & Fit Invalid Input

Other Information

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