Name:

Email:

Phone number:

Job site address, including city and zip code:

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.

Please mark that you accept the following:

++There will be additional charges if there is excessive wait time, inaccurate answers or we have to return to repair damages or buff dust from remodeling.

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.