Moving Into the London Borough of Enfield

Moving Into the London Borough of Enfield Form

Property Details Property reference (if known):

Property Name:

Address:

<br />
											<br />
											<br />
											<br />
											<label  class="contactLabel" for="propertypostcode">Postcode: </label> 
											<input class="contactInput" type='text' name='Property Postcode' id="propertypostcode" size='37' tabindex='4' value=''/>
											<br  />
									</fieldset>
										
									<fieldset>
										<legend>Move Details</legend></legend>
											<br  />
											<label  class="contactLabel" for="dateMovedIn">Date you move in: i.e 24/06/2008</label> 
											 <input class="contactInput" type='text' name='Day' id="email" size='1' maxlength=2 tabindex='5' value=''/>
											 <input class="contactInput" type='text' name='Month' id="email" size='1' maxlength=2 tabindex='6' value=''/>
											 <input class="contactInput" type='text' name='Year' id="email" size='1' maxlength=4 tabindex='7' value=''/> 
											
										    <br /><br>

<label  class="textLabel" for='propertyEmpty'>Is the
											property still empty?: </label>
											
											<div id="radioLeft">
											<input class="radio" type="radio" id="yes" name="Is the property still empty" title="Yes" value="Yes"  tabindex='8' />
											<label class="radio" for="propertyEmptyYes">Yes</label>
												<br />
												
												<input class="radio" type="radio" id="no" name="Is the property still empty" title="No" value="No" tabindex='9'>
												
												<label class="radio" for="propertyEmptyNo">No</label>
												<br />
											</div>
											
											<label  class="textLabel" for='discount'>Are you the only adult occupier and do you wish to apply for a single person discount?: </label> 
											
											<div id="radioLeft">
												
												<input class="radio" type="radio" id="discountYes" name="Single person discount" title="Yes" value="Yes"  tabindex='10'>
												<label class="radio" for="propertyEmptyYes">Yes</label>
												<br />
												<input class="radio" type="radio" id="discountNo" name="Single person discount" title="No" value="No" tabindex='11'>
												<label class="radio" for="propertyEmptyNo">No</label>
												<br />
											</div>
												<br /><label  class="contactLabel" for="dicountDate">Date single person discount should start from: i.e 24/06/2008</label> 
											 <input class="contactInput" type='text' name='Discount Day' id="email" size='1' maxlength=2 tabindex='12' value=''/>
											 <input class="contactInput" type='text' name='Discount Month' id="email" size='1' maxlength=2 tabindex='13' value=''/>
											 <input class="contactInput" type='text' name='Discount Year' id="email" size='1' maxlength=4 tabindex='14' value=''/>
											<br /><br /><br /><br /><br>
							</fieldset>
										
									<fieldset>
										<legend>Your Details</legend></legend>
											<label class="contactLabelPadding"  for="name">Name:</label> 
											<input class="contactInputPadding"  type='text' name='Name' id="name" size='37' tabindex='15' value=''/>
											<br />
											<br />
											<br />
							
										
											<label  class="contactLabel" for="email">Email: </label> 
											<input class="contactInput" type='text' name='Email' id="email" size='37' tabindex='16' value=''/>
											<br />
											<br />
											<br />
											<label  class="contactLabel" for="movedDate">Date: i.e 24/06/2008</label> 
											 <input class="contactInput" type='text' name='Moved Day' id="movedDay" size='1' maxlength=2 tabindex='17' value=''/>
											 <input class="contactInput" type='text' name='Moved Month' id="movedMonth" size='1' maxlength=2 tabindex='18' value=''/>
											 <input class="contactInput" type='text' name='Moved Year' id="movedYear" size='1' maxlength=4 tabindex='19' value=''/>
											<br /><br /><br /><label class="contactLabel" for="phone">Phone: </label> 
											<input class="contactInput"   type='text' name='Telephone Number' id="phone" size='37' tabindex='20' value=''/>
											<br />
												</fieldset>
										
											<fieldset>
										<legend>Property Information</legend></legend>
											<br />
											<label  class="contactLabel" for="isThe4Property">Is the property: </label>
											<br />
										
											<select class="contactInput" id="propertytype" name="Is the property?">
                  								<option value="" selected="Is the property?">PleaseSelect ...</option>
                  								<option value="useful">Owned - Furnished</option>
                 								<option value="quite useful">Owned - Unfurnished</option>
                 								<option value="not useful">Rented - Private Furnished</option>
												<option value="useful">Rented - Private Unfurnished</option>
                 								<option value="quite useful">Council - Furnished</option>
                 								<option value="not useful">Council - Unfurnished</option>
												<option value="not useful">Uninhabitable</option>
											</select> 
											<br />
											<br />
											<br />
											<label class="contactLabel" for="phone">Description (eg house, ground floor flat): </label> 
											<input class="contactInput"   type='text' name='Description New' id="phone" size='37' tabindex='21' value=''/>
											<br />
												</fieldset>
										
									<fieldset>
										<legend>Personal Circumstances</legend></legend>
										<br />
										
											<label  class="textLabel" for='discount'>Do you get Council Tax/Housing Benefit?:</label> 
											
											<div id="radioLeft">
												
												<input class="radio" type="radio" id='counciltax/housingbenefitYes' name="Council Tax / Housing Benefit" title="Yes" value="Yes"  tabindex='22'>
												<label class="radio" for="counciltax/housingbenefit">Yes</label>
												<br />
												<input class="radio" type="radio" id='counciltax/housingbenefitNo' name="Council Tax / Housing Benefit" title="No" value="No" tabindex='23'>
												<label class="radio" for="counciltax/housingbenefit">No</label>
												<br />
											</div>
												<br />	
				
				
						<label  class="textLabel" for='studentDiscount'> Are you a student?(We may be able to reduce your bill):</label> 
											
											<div id="radioLeft">
												
												<input class="radio" type="radio" id="studentYes" name="Are you a student?" title="Yes" value="Yes"  tabindex='24'>
												<label class="radio" for="student">Yes</label>
												<br />
												<input class="radio" type="radio" id="studentNo" name="Are you a student?" title="No" value="No" tabindex='25'>
												<label class="radio" for="student">No</label>
												<br />
											</div>
												<br />	
													<label  class="textLabel" for='studentDiscount'> Are you disabled? (We may be able to reduce your bill):</label> 
											
											<div id="radioLeft">
												
												<input class="radio" type="radio" id="disabledYes" name="Are you disabled?" title="Yes" value="Yes"  tabindex='26'>
												<label class="radio" for="diabled">Yes</label>
												<br />
												<input class="radio" type="radio" id="disabledNo" name="Are you a disabled?" title="No" value="No" tabindex='27'>
												<label class="radio" for="disabled">No</label>
												<br />
											</div>
													<br />	
													<label  class="textLabel" for='studentDiscount'>Have you ever lived in Enfield?:</label> 
											
											<div id="radioLeft">
												
												<input class="radio" type="radio" id="livedYes" name="Have you lived in Enfield?" title="Yes" value="Yes"  tabindex='28'>
												<label class="radio" for="diabled">Yes</label>
												<br />
												<input class="radio" type="radio" id="livedNo" name="Have you lived in Enfield?" title="No" value="No" tabindex='29'>
												<label class="radio" for="disabled">No</label>
												<br />
											</div>
											<br />
											<label class="contactLabel"  for="previousAddress">If yes, what was your address? </label> 
											<textarea class="contactInput"  name='Previous Address' id="previousAddress" cols='23'rows='2' tabindex='30'  >
											<br />
							</fieldset>

<fieldset>
								<legend >If Owned</legend>

<br />

<label  class="contactLabel" for="completeDate">Date of purchase: i.e 24/06/2008</label> 
											 <input class="contactInput" type='text' name='completed Day' id="completeDay" size='1' maxlength=2 tabindex='31' value=''/>
											 <input class="contactInput" type='text' name='Completed Month' id="completeMonth" size='1' maxlength=2 tabindex='32' value=''/>
											 <input class="contactInput" type='text' name='Completed Year' id="completeYear" size='1' maxlength=4 tabindex='33' value=''/>
											<br />
											<br />
											<br />
											<br />
												<label class="contactLabel" for="previousOwners">Name of previous owners: </label> 
											<input class="contactInput"   type='text' name='Previous Owmers' id="previousOwners" size='37' tabindex='34' value=''/>
											<br />
											<br />
											<br />
											<br />
											<label class="contactLabel"  for="forwardingAddress">Forwarding address of previous owners:</label> 
											<textarea class="contactInput"  name='Previous Address' id="previousAddress" cols='23'rows='2' tabindex='35'  >
											<br />
											<br />
											<br />
											<br />
											<br />
											<label class="contactLabel" for="forwardingPostcode">Postcode:</label> 
											<input class="contactInput"   type='textarea' name='Previous Owmers' id="forwardingPostcode" size='37' tabindex='36' value=''/>
											<br />
								</fieldset>
								
									<fieldset>
								<legend >If Rented</legend>	
											<br />

<label  class="contactLabel" for="completeDate">Date tenancy began: i.e 24/06/2008</label>
<input class="contactInput" type='text' name='Tenancy Start Day' id="tenancyStartDay" size='1' maxlength=2 tabindex='37' value=''/>
<input class="contactInput" type='text' name='Tenancy Start Month' id="tenancyStartMonth" size='1' maxlength=2 tabindex='38' value=''/>
<input class="contactInput" type='text' name='Tenancy Start Year' id="tenancyStartYear" size='1' maxlength=4 tabindex='39' value=''/>
											<br />
											<br />
											<br />
											<br />
											
															<label class="contactLabel" for="landlord">Name of landlord or agent:</label> 
											<input class="contactInput"   type='text' name='Previous Owmers' id="landlord" size='40' tabindex='40' value=''/>
											<br />
											<br />
											<br />
											<br />
											
													<label class="contactLabel" for="landlordAddress">Address of landlord or agent:</label> 
												<textarea class="contactInput"  name='Previous Owners Address' id="previousOwnersAddress" cols='23'rows='2' tabindex='41'  >
											<br />
											<br />
											<br />
											<br />
											
													<label class="contactLabel" for="landlordPostcode">Postcode:</label> 
											<input class="contactInput"   type='textarea' name='Landlord Owmers' id="landlordPostcode" size='37' tabindex='42' value=''/>
											<br />
											<br />
										
											
														<label class="contactLabel" for="landlordPhone">Phone:</label> 
											<input class="contactInput"   type='textarea' name='Landlord Phone' id="loandlordPhone" size='37' tabindex='43' value=''/>
											<br />
								</fieldset>

<br />
									
									<label  class="textLabel" for="details"></label> 
									<div style="margin-left:5%; margin-right:5%;">
									<div style="margin-left:5%; margin-right:5%; padding:10px; text-align:center;">
										<input type='submit' class='smallbutton' tabindex='44' value='Send Now'/>
										<input type='reset' class='smallbutton' value='Clear and Reset' tabindex='45'/>
									</div>
								</div>
							</fieldset>
						</form>
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