ORDER FORM

Order Form

Contractor License #825456

Use this online order form as a convenient way to expedite the processing of your order. You can also print this off and fax it to
818 541-0403.

We will contact you to finalize and schedule the job including providing you with an accurate telephone estimate of the price for the job.

Or call (800)55-PACIFIC or (818) 541-0404 if you prefer to place your order by phone.
* = information required

Customer Name:	* (Owner or Company name)
Person Requesting:	* Title:
	Are you a new customer? Yes No
Phone No:	* (your phone - to confirm & finalize order)
Your email:
Job Site Name:	(eg. Name of Apt bldg)
Job Site Address:	*
Job Site City:	*	Zip:		*
Unit Number(s):	If job is in an apartment, which unit(s)
Vacant?	* (is this a vacant unit or house? - yes or no)
Site Contact:			Site Phone:
Tenant Name: (if applic.)			Tenant Ph:
Description of work to be done:	*
Color:	(White, Almond or Custom)
Special Instructions:
(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.