Name *

First Name

Last Name

Phone *

(###)

###

####

Site Start Date *

MM

DD

YYYY

Your Chosen Appliance Pack *

Titanium (Black Models)

Contemporary (White/Stainless Steel)

Build Type *

Single Storey

Double Storey

Estimated Handover Date *

Please note, Residentia Group will contact you 2 weeks prior to this date to confirm the exact delivery.

MM

DD

YYYY