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Water Damage Intake Form

Water Damage Intake Form

Name *

First

Last

Email to send you your Appt time *

Your Street Address (required) *

Your City (required) *

Your Zip (required) *

Cell Phone # and Work or Home # (required) *

Who Are You?

I'm the Homeowner
I'm Renting
Contractor/Cleaning Company
Commercial Client

What type of Service(s) do you need? (Choose ALL that apply)

Water Damage Carpet Repair
Carpet Patch(es)
Carpet Repair(s) misc.
Carpet Stretching
Carpet Dyeing
Carpet Cleaning
Tough Stain Removal
Carpet Installation
Other

Do You need pad in part or all of your room?

yes
No
I dont know

Quantity of Repairs? Size of Each, Location of Each?Example: Area 1 Name, size & type of damage; Area 2 Name, size & type of damage etc( Put an imaginary rectangle around each damaged area, what is the Length & Width of that rectangle? ie. 6" X 2ft etc.

(for example. 2 rooms water damaged (Master Bedroom & Living room) need pad in only about 8 X 8 etc?

How Big are the Rooms that have Water Damage?

(for example. Living Room is 24 X 15 etc)

What is your type of Carpet- Please Select

Polypropylene or Apartment Carpet
Nylon Carpet
Wool Carpet

1st & 2nd Choice For Appt: Date & Time

please select your 1st & 2nd option so we can accomodate you if at all possible

Is there anything you specifically want to ask us or Additional info to tell us?

FINAL INSTRUCTIONS: TEXT PICTURES TO (855) 723-3022: (1) We Need a picture of the entire room with the damage in it. Send each room separately and each individual damage in that room separately. (2) Send each room separately and each individual damage in that room separately. (4) Try to count each patch

Yes, I texted them
Yes, I uploaded them here below under 'File Upload'
No, I did not
I emailed them instead

File Upload

Click or drag files to this area to upload. You can upload up to 20 files.

Water Damage Intake Form was last modified: March 2nd, 2024 by admin

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