*Your name

*Your email address

*Establishment Name

*Establishment Category Choose a category ..... Retail ...... 1. Shopping Centres 2. Supermarkets 3. Department Stores 4. Convenience Stores 5. Food Superstores 6. GM Superstores 7. Self Storage Operators 8. Markets Hospitality ..... 9. Hotels 10. Restaurants 11. Quick Service/Fast Food Restaurants 12. Cafes & Coffee Shops 13. Pub & Wine Bars 14. Night Clubs 15. Conference & Banqueting Venues Leisure ..... 16. Leisure and Recreation Centres 17. Community Centres 18. Parks & Gardens 19. Garden Centres 20. Water & Theme Parks 21. Visitor Attractions 22. Outdoor Events Venues Heritage ..... 23. Museums & Galleries 24. Historic Buildings 25. Town Halls 26. Libraries 27. Places of Worship & Halls 28. Cemeteries & Crematoria Entertainment ..... 29. Theatres 30. Cinemas 31. Bingo Halls/Casinos 32. Concert Halls 33. Exhibition Halls Holiday Parks ..... 34. Camping & Touring or Static Caravan Sites Education ..... 35. Nursery Schools 36. Primary Schools 37. Secondary Schools 38. Higher Education Establishments 39. Education Centres Health ..... 40. Hospitals 41. Surgeries 42. Day Centres 43. Nursing & Residential Homes Offices ..... 44. Commercial & Public Car Parks 45. Public and Private Public Toilets 46. Full Time Attended 47. Non-Attended 48. Automatic/Semi-Automatic Mobile Toilets 49. Mobile/Portable Toilets Transport ..... 50. Motorway Service Areas 51. Roadside Restaurants/Service Stations 52. Railway Stations 53. Trains 54. Airports 55. Ferry Ports 56. Ferries 57. Bus & Coach Stations Sport ..... 58. Sports Venues & Stadia 59. Sports & Health Clubs Beaches ..... 60. Public or Privately Owned - within 50m of shoreline  

*Establishment Address

Establishment Phone No. (if known)

Establishment Contact (e.g. Name of Manager)

Establishment Contact Position if known (e.g. Manager)

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If other, please describe