| |
|
|
|
|
Purchase
Order Number:
|
|
|
Work
Order Number:
|
|
|
A/R
Maintenance Agreement Number:
|
|
|
Estimate
Number:
(located in top right corner)
|
|
|
*Owner
or Authorized Agent Name:
|
|
|
*Owner
or Authorized Agent Phone:
|
|
|
Company
Name:
|
|
|
*Owner
or Company Street:
|
|
|
*Owner
or Company City:
|
|
|
*Owner
or Company State:
|
|
|
*Owner
or Company Zip:
|
|
|
*Owner or Authorized Agent Email:
|
|
|
*Owner
or Authorized Agent Phone:
|
|
|
Company
Phone:
|
|
Location
Information:
|
|
Subdivision/Development
Name:
|
|
|
Type
of Structure:
|
|
|
Occupied:
|
|
Yes |
|
| |
|
Occupants
Name |
|
| |
|
Occupants
Phone |
|
| |
|
Occupants
Email |
|
| |
|
No |
|
|
*Jobsite
Address:
|
|
|
Jobsite
Apt/Unit #:
|
|
|
*Jobsite
City:
|
|
|
*Jobsite
Zip:
|
|
|
Jobsite
County:
|
|
|
Gate
Code:
|
|
|
Lock
Box Code:
|
|
Repair
Information:
|
|
*Repair/Problem:
|
|
|
|
|
|
|
Leaking |
|
| |
|
|
|
|
|
Skylight Leaking/problem |
| |
|
Location/Room |
|
|
|
|
|
| |
|
Approximate
size |
|
|
|
|
Missing Roofing Product |
| |
|
|
|
|
|
Cracked Tile |
|
|
|
|
Emergency Tarping Requested |
|
|
|
Other |
|
| |
|
|
Product
Information
|
|
*Type
of Product
|
|
|
|
|
Steep
Slope Roofing
|
|
|
| |
Asphalt
3-Tab Shingles |
|
| |
|
Owens Corning |
|
| |
|
Color:
|
| |
|
Certainteed |
|
| |
|
Color
|
| |
|
Atlas |
|
| |
|
Color
|
| |
|
Other |
|
| |
|
|
| |
Asphalt
Dimensional/Architectural Shingles |
| |
|
Owens Corning |
|
| |
|
Color:
|
| |
|
Certainteed |
|
| |
|
Color
|
| |
|
Atlas |
|
| |
|
Color
|
| |
|
Other |
|
| |
|
|
| |
|
Cedar
Shake/Wood |
|
| |
|
Metal
Panels
|
| |
Tile |
|
| |
Clay |
|
| |
|
Altusa II |
|
| |
|
Barrel |
|
| |
Concrete |
|
| |
|
Villa |
|
| |
|
Flat |
|
| |
|
Other:
|
|
Low
Slope Roofing/Flat Roofing:
|
|
|
| |
|
B.U.R./Tar and Gravel |
| |
|
Modified Bituman/Rolled Mineral Surface |
| |
|
Color:
|
| |
|
Waterproofed/Coated |
| |
|
Sheet Metal |
|
| |
|
Spray Foam |
|
| |
|
PVC |
|
| |
|
EPDM |
|
| |
|
TPO |
|
| |
|
Other,
Please explain: |
|
| |
|
|
|
*
# Of Floors/Stories:
|
|
|
|
*Is
the roof walkable?:
|
Yes
No |
|
|
*Staining
on Walls/Ceiling:
|
Yes
No
Unavailable |
|
*Age
of Roof:
|
|
|
| |
|
|
|
|
Found
us by:
|
|
|
|
| |
|
Web
search |
|
| |
|
Phonebook |
|
| |
|
Book/Page
|
| |
|
Prior
Customer |
|
| |
|
Referral |
|
| |
|
Name
|
| |
|
Vehicle |
|
| |
|
Yard
Sign |
|
| |
|
Other:
|
|
Additional
Information:
|
|
|
|
|
|
|
*Limited
Labor Warranty:
|
|
|
*Rates:
|
|
|
| |
|
|
|
|
|
| |
|
|
|
|
|
AUTHORIZATION TO PROCEED WITH WORK; I am the Owner
or Authorized Representative (herein after Owner)
of the Jobsite Address at which work is to be done.
I hereby authorized Affordable Roofing by John Cadwell,
Inc.(herein after A/R) to perform said work, and to
use such labor, materials and equipment as A/R deems
advisable. I understand that if I have selected the
Standard Rate then schedule work on a Holiday, Saturday,
Sunday or After Hours the Standard Rate will double
along with time minimum charge and maximum to be charged.
A/R standard hours of operation are Monday-Friday 7am
to 3 pm. When possible before and after pictures will
be provided.
I have read and understand the Contract
Terms. I hereby authorized Affordable Roofing
by John Cadwell, Inc to perform the work in accordance
with the term specification, conditions, limited labor
warranty and I agree to pay according to the Terms.
If work to be performed is expected to exceed the
limit stated in the Standard or Emergency as listed
a written Estimate is requested in place of this Repair
Work Authorization.
I Accept
I Decline
I understand and acknowledge that by accepting this
work I am providing my electronic signature for A/R
to proceed with this work in accordance with any and
all applicable laws specifically including, but not
limited to, the Federal Electronic Signatures in Global
and National Commerce Act and/or Chapter 668, Florida
Statutes.
Include Copy To My E-mail Address
|
|
|
Copyright 2008©, Affordable Roofing
By John Cadwell, Inc.
|
