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Date:*
Name: *
Email: *
Job Site Address:*
City/Borough:*
County:*
State:*
Zip:*
Type of Product Needed :
(Check all that apply)
Vinyl Windows and Doors
Aluminum Windows and Doors
Home Tel #:* (eg. 555-555-5555)
Work Tel #:* (eg. 555-555-5555)
Other Tel #:* (eg. 555-555-5555)
Best Time to Call:*
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Current Use of Building:
# of Floors:
# of window/door units needed:
Current Window Types (D/H, Casement)
Current Window Material: (Check all that apply) Wood
Vinyl
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Other
Possible Replacement Types:
Possible Replacement Material:
Other Replacement Items:
Special Notes:
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