Fytowall®

Request for information on vertical green walls

Mr. / Ms. (Verplicht)

Mr. Ms.

Initials / Christian Name

Surname (Verplicht)

Private / Business

Private Business

What is your core business

Contact person

Visitors address

Postal address (street) (Verplicht)

House number (Verplicht)

Postal code (Verplicht)

City / Town / Village (Verplicht)

County (Verplicht)

Country (Verplicht)

Telephone number

Mobile number

Fax

E-mail

Website

Information about your vertical green wall

Type of Wall

Indoor Outdoor

Carrying wall

Yes No

Type of Buidling

House Appartement / Flat Office Building Sound Barrier Other

Buidling is used for

Living in Office Hotel / Restaurant / Pub Production Other

Property Owned / Rented

Owned Rental

Year of construction Buidling / Wall

Backing wall material

Total wall measurement (Length x Height)

Measurement of the required green wall (Length x Height)

Floor material under the wall

Water supply in close vacinity of green wall

Yes No

Electricity supply in close vacinity of green wall

Yes No

Are there any particular items on/in the wall which need mentioning

Your photo / sketch of the situation

Information on required plants and your choice for the frame

Your choice of plants

Indoor Outdoor Ornamental Grasses

Your frame choice

Wooden Lead Zinc Stainless Steel Metal No Frame (e.g. green wall, wall-to- wall) Other

Required delivery time

Delivery time within

2 - 3 weeks 8 weeks Other

Additional remarks