Home Remodeling Application Form

Name*

First NameLast Name

Appointment Date*

MonthDayYear

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Home Phone*

Area CodePhone Number

Cell Phone*

Area CodePhone Number

Work Phone

Area CodePhone Number

E-mail*

Square footage of home*

# of bedrooms desired

# of bathrooms desired

In the event we have to reach you while construction is taking place what is your preferred means of contact?*

What type of service applies to you?*

First Time AppointmentOne Time AppointmentWeekly ServiceMonthly Service

How do we gain entrance?*

Keys with officeKeys with doormanSomeone will grant access

SPECIAL INSTRUCTIONS

Please type your full name. This will serve as your electronic signature.*

In the event that we have to temporarily or permanently change your construction consultant, how would you like to be notified?*

Please email mePlease call meDon't email/call, I am OK with any replacements

Home /Office Remodeling Services (859)-317-0643