Please sent completed form to:

1. Please sent completed form to: Severn Trent Water, Asset Data Management, GIS Mapping Team, PO Box 5344, Coventry CV3 9FT. Fax 02477 - 715862 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. Internal use RMS Job ID Customer Details (BLOCK CAPITALS) Site Information Date (dd/mm/yy) Site plan attached? Yes No Name of company Site address Address Postcode Postcode Grid reference X Y Contact name Please provide a plan to ensure complete coverage of the mapping area you require Telephone number By signing and ticking this form you are agreeing to STW’s Terms and Conditions Signed ……………………………………………………………Tick Fax number Your reference Products Total no. Cover and invert levels will be provided where available Small site * X Additional copy X Water AND Sewer maps £35.25 £11.75 Water map only £23.50 £5.88 Sewer map only £23.50 £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 ………………………………………………………………………………………………………………………………………………………………….. 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 Name on card: Card No. Issue No. Expiry date (mm/yy) Valid from (mm/yy) Security No. A receipt is provided with all plans 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.