BUILDER:

SUPERVISOR:   CONTACT #:

?  JOB

Address: 

Homeowner: 

?  WORK REQUESTED

-Trim Out:   Requested Completion Date:   House Access?

- Homeowner Consultation:   ($65) Prepaid?  Yes No  

   Contact Name:    Phone: 

-Service Call:    Issue:

-Warranty Request:   Issue:

*If service requested is not a warranty issue, a trip charge of $55.00 will be billed.  Example: gas or    

  electrical (other subcontractor) issues.

Notes:

Directions:

SIGNATURE:   DATE:

Please fax back with desired completion date and we will fax confirmation date as close as possible. Thanks for your business! 

**AGH Use Only:

Items prepaid due at t/o: 

Scheduled date:   Resolution: 

MFG Warranty:   SFC Warranty:   BLDR. CHG.: