Please sent completed form to:Severn Trent Water, Asset Data Management, GIS Mapping Team, PO Box 5344, Coventry CV3 9FT. Fax 02477 - 715862

Internal useRMS Job ID

The GIS Mapping Team can only provide water and sewer map locations of Severn Trent Water’s underground assets. N.B. SERVICE PIPES ARE THE RESPONSIBILITY OF THE PROPERTY OWNER AND WILL NOT BE SHOWN ON WATER/SEWER MAPS.

Customer Details (BLOCK CAPITALS)

Date (dd/mm/yy)

Name of company

Address

Postcode

Contact name

Telephone number

Fax number

Site Information

Site plan attached? Yes No

Site address

Postcode

Grid reference X Y

Please provide a plan to ensure complete coverage of the mapping area you require

By signing and ticking this form you are agreeing to STW’s Terms and Conditions

Signed ……………………………………………………………Tick

Products

Water AND Sewer maps

Water map only

Sewer map only

Cover and invert levels will be provided where available Small site *

£35.25

£23.50

£23.50

X Additional copy

£11.75

£5.88

£5.88

* For larger sites please provide a plan of the required area and we will inform you of the total cost. Total cost:

For copies of additional plans when requested with the initial plan, please see costs as above (all costs shown include VAT)

Additional order forms can be downloaded from our website www.stwater.co.uk

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Payment Details

Payment method: Requests for multiple locations require individual location details, however one total payment will be sufficient

Cheque (Please make cheques payable to Severn Trent Water) Credit/Debit Card

Please note that payment by American Express / Diner / Electron cards or cash in the post is NOT accepted. Please print this form, write in your card details and post to the address at the top of this form or fax to 02477 715862.

Please select from the following accepted card types: Delta Mastercard Switch Maestro Visa

Issue No.

Name on card:

Card No.

Expiry date (mm/yy) Valid from (mm/yy) Security No.

Viewing records: Appointments can be made to view Severn Trent Water underground assets at our Coventry office free of charge. To book an appointment call 0845 601 6616 or fax 02477 715862. Last appointment is at 3.30pm (Mon – Thurs) and 3.00.pm (Fri).

Opening hours: Monday to Thursday 9.00am – 4.00pm and Fridays 9.00am – 3.30pm. Sewer records can be viewed at the relevant Local District or Metropolitan Council free of charge.

A receipt is provided with all plans

X Total no.

Your reference