First Name
:
Last Name
:
Address
:
City
:
State
:
District of Columbia Maryland Virginia
Postal Code
:
Phone
:
Alternate Phone
:
Best time to call
:
Morning Afternoon Evening
Email Address
:
Job Description
(Please describe in sufficient detail)
:
Project Budget
:
Estimated time to start
:
1-2 Weeks Within 1 Month 1-3 Months Immediately, my wife is nagging me constantly Immediately, my husband is glued to the couch
How did you hear about us
?
Internet
Postcard Mailer
Magnet Mailer
Newspaper
Realtor
Newsletter
Referral
Yellow Pages
Clipper Magazine
Home Show
Corporate Partner
Other
I UNDERSTAND AND ACKNOWLEDGE THAT Home Improvement Remedies IS A REFERRAL SERVICE AND WILL REFER
CONTRACTORS TO ME. ANY ARRANGEMENTS MADE, OR CONTRACTS NEGOTIATED ARE BETWEEN ME AND THE CONTRACTOR. Home Improvement Remedies HAS NOT MADE ANY
WARRANTIES, EXPRESS OR IMPLIED TO ME AND SPECIFICALLY EXCLUDED FROM THIS JOB ORDER FORM ARE IMPLIED WARRANTIES OF MERCHANTABILITY AND THAT
Home Improvement Remedies SHALL NOT BE HELD LIABLE FOR ANY DELAY OR FAILURE OF CONTRACTOR TO RENDER SERVICES DUE TO FEDERAL,
STATE OR MUNICIPAL ACTION OR REGULATION; FIRED DAMAGE TO OR DESTRUCTION IN WHOLE OR IN PART OF HOMEOWNERS PREMISES; LACK OF OR INABILITY TO
OBTAIN RAW MATERIALS, LABOR, FUEL, OR SUPPLIES; OR ANY OTHER CAUSES, CONTINGENCIES OR CIRCUMSTANCES WHICH PREVENT OR HINDER CONTRACTOR
FROM RENDERING SERVICES OR COMPLETING ITS CONTRACT WITH ME. I HEREBY HOLD Home Improvement Remedies HARMLESS FROM ANY DEFECT IN
WORKMANSHIP, DEFAULT, DAMAGE, INJURY OR EXPENSE ARISING OUT OF THE WORK PERFORMED BY A CONTRACTOR REFERRED AND HIRED BY ME FOR ALL JOBS.