This form should only be used for non-emergency repairs. Should you have any emergency repair please contact a member of the Customer Service Team on either 0113 2504337, 01405 766073, 01142940157. If its out of office hours please contact Astraline on 0800 9803001.

Residents Name*
Flat/House Number*
Street*
Town*
Postcode*
Daytime Contact Number*	e.g. 102325 (no spaces allowed)
Email address*	e.g. name@host.com
Date the fault occurred	e.g. dd/mm/yyyy
Have you previously reported this repair?	Yes No
Is this an internal or external fault?	Internal External
Please describe the fault*
Access Arrangements
Name of Person to contact*
Access Daytime Telephone Number (if different from above)
Please enter anti-spam security code:
* Field is Required