DATE_________ JOB _________________ ORDER FORM PAGE #1 OF 3
Customer Name __________________________________ Salesman _____________________
Address ________________________________________________________________________
City ______________________________ State _______________ Zipcode ____________
Home Phone _______________________________ Work Phone _________________________
Is Someone Home During the Day? __ Yes __ No Financing Required? ___ Yes ___ No
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Home Make ___________________ Model _______________________ Year ____________
Size on Title ______ X _________ Actual Size ________ X _____________
Heating Method _______ Oil ________ Gas ________ Electric ______________Other
Outside Electric _____ Yes ______ No Permit Required? ______ Yes _____ No
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HOME CONDITIONS Is There Evidence of water Damage? ____ Yes ____ No
Ceiling Stains ____ Yes ____ No Details _______________________________________
Wet Carpeting ____ Yes ____ No Details _______________________________________
Panel Stains ____ Yes ____ No Details _______________________________________
Other ____ Yes ____ No Details _______________________________________
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JOB ESTIMATE

Width _____________ ft. + Overhang ______________ in. = Total Width ____________
Length ____________ ft. + Overhang ______________ in. = Total Width ____________
Total Width __________ ft. X Total Length ______________ = Total Sq. Ft. _____________
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