Name:

Email:

Phone number:

Job site address:

Property name and/or apartment number, if applicable:

Cross street:

Parking Instructions, if applicable:

Door access information (ie: lockbox location, access code):

Onsite name and contact info for day of job, if different than above:

Billing information, if different than above:

Room that the technician will be working in (ie: main bath, master, upstairs, basement). It is helpful to mark the damage with blue tape.

Color of existing tub, shower or sink:

YesNo+++Does the faucet or valve leak/drip?
++++++++++++++++We cannot work if a fixture is leaking/dripping.

YesNo+++There is running hot water and drainage in the fixture being repaired.

YesNo+++Electrical outlets and finished lighting is working in the bathroom.
++++++++++++++++Not temporary lighting. We cannot tint to match the color with temporary lighting.

YesNo+++Remodeling is finished (no bare subfloor, bare drywall, exposed studs, etc).
++++++++++++++++We need a clean and dust free environment, repairs are scheduled as the final step.

YesNo+++Allow 48 hours to cure before use.

YesNo+++Has anyone in your home shown signs of Covid-19 or been in close contact with someone recently diagnosed with Covid-19?

There will be charges assessed if:
- We arrive on site and are unable to do the repair and/or
- We have to return to site due to remodeling dust, dripping faucets, etc.

If you need to add any additional information, please use the space below.