Notification of the demolition of your building in the case of underground infrastructure or request for a (temporary) move of our above-ground infrastructure (on facade)

All fields are mandatory except those where "optional" is mentioned.

Personal data
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{{errorMessages.firstname.required}} {{errorMessages.firstname.pattern}} {{errorMessages.firstname}}
{{errorMessages.name.required}} {{errorMessages.name.pattern}} {{errorMessages.name}}
Installation address
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{{errorMessages.number.required}} {{errorMessages.number.pattern}} {{errorMessages.number}}
{{errorMessages.box.required}} {{errorMessages.box.pattern}} {{errorMessages.box}}
{{errorMessages.zip.required}} {{errorMessages.zip.pattern}} {{errorMessages.zip}}
{{errorMessages.city.required}} {{errorMessages.city.pattern}} {{errorMessages.city}}
{{errorMessages.contactnumber.required}} {{errorMessages.contactnumber.pattern}}
{{errorMessages.mobile.required}} {{errorMessages.mobile.pattern}} {{errorMessages.mobile}}
{{errorMessages.fixnumber.required}} {{errorMessages.fixnumber.pattern}} {{errorMessages.fixnumber}}
{{errorMessages.email.required}} {{errorMessages.email.pattern}} {{errorMessages.email}}
{{errorMessages.installdate.required}} {{errorMessages.installdate.pattern}} {{errorMessages.installdate}}
{{errorMessages.comments.required}} {{errorMessages.comments.pattern}} {{errorMessages.comments}}
{{errorMessages.type.required}} {{errorMessages.type.pattern}}

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