ORDER FORM

Order Form

Contractor License #825456

This form is for use by existing customers. New customers please call or request an estimate here.

Order online by submitting the form below, or print and fax it to
818 541-0403. After we receive your order we will call to schedule.

Call (800)55-PACIFIC or (818) 541-0404 if you have questions, or to place your order by phone.
* = information required

Customer Name:	* (Owner or Company name)
Person Requesting:	* Title:
Phone No:	* (for confirmation of your order)
Your email:
Job Site Address:	*
Job Site City:	*	Zip:		*
Unit Number(s):	If an apartment, which unit number(s)
Vacant?	* (is this a vacant unit or house? - yes or no)
Job Site Contact:			Site Phone:
Tenant Name: (if applic.)			Tenant Ph:
Description of work to be done:	*
Color:	White Almond Custom (specify any custom color below)
Special Instructions:
When Needed:	Please note when you would like the work done. If there is a specific deadline, please note the date and any relevant info related to scheduling. We will do our best to accommodate.
Please indicate who we should contact for scheduling the work: Person Requesting or Job Site Contact Tenant
* Type "yes" to indicate that you agree to our terms of service, and that you understand prices will be based on our standard price sheet and finalized at the job site once the site has been inspected. Note: No one should be in the unit for approximately 4 hours after the job is done to allow time for fumes to clear. We will contact you to finalize and schedule your order. Any questions please discuss at time of scheduling.