DyeBold Carpet Dyeing Form

1
Select Item to be restored
Rug (Describe below)
Wall to Wall Carpet
Upholstery
Other (Describe below)
2
Current Issues: Select all that applyGive details below Regarding Type of Spill/Stain and ANY thing done to the area.
Bleached/Faded Areas
Stained Areas
Color Manufacturing Defect
Outdaded Color
Structural Fiber Damage
Other
3
Tell us about the damage:1) What/Who caused it? 2) When Did it Occur? 3) What was done do it up to this point?
4
Type of TextilSelect all that Apply.
Carpet in 1 Room
Carpet in 2 or More Rooms
Upholstery
5
Item DescriptionFor estimate, Please complete all known fields.
Item Description (ex: Persian Rug, or Custom Carpet)
Fiber Type/Age/Manufacturer
Estimated Value Prior To Damage
Location of Item (Ex: Guest Room/Conference Room)
Purchase Cost
*Notes (Any additional pertinent info)
6
Affected Areas Select all that apply
1 Room Only_Wall to Wall Carpet (cannot be moved)
2 or More Rooms Affected_Wall to Wall Carpet (Cannot be moved)
Upholstery
2 or More Upholstery
Other
7
Services All Requested
Spot dyeing (Faded Areas)
Full room dyeing (restore or change color) *Available for Commercial/Non-Profit Properties only
Stain removal (Dark Stains)
Carpet Repair (for structural fiber damage (burn/pet damage etc)
Other
8
Room 1 name/Damage description Ex: Master bedroom/ 2 bleach spots occurred 6 months ago
9
Upload photo/s. Include relevant images. Take Overall Photo, And Photos of damaged areas. Add ruler/pencil by area for sizing. *Needed for estimate
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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10
Additional rooms name/Damage description Ex: Living room / 2 bleach spots occurred 6 months ago, additional room
11
Upload additional photo/s of damaged areas with ruler/pencil by area for sizing.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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12
Contact InformationLocation where services will be performed.
Property Name
Street Address/Suite
City
State / Province
Postal / Zip Code
Please Select
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Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
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Austria
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The Bahamas
Bahrain
Bangladesh
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Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
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India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
13
Your InfoName of person to be contacted regarding this inquiry. Include Parties to be CC’d in Notes
Your Name
Commercial -Business Owner/Representative
Commercial - I’m a contractor
Residential - Home Owner
Residential -Tenant (Apartment)
Other (describe in Notes)
Role
Company (if home owner/tenant leave blank)
Email
Phone#
Please Select
Please Select
Text
Email
Call
Preferred Method of Contact
*Notes (Any pertinent info)
14
Property informationName of person to be contacted regarding this inquiry.
Property Type
Homeowner
Tenant
Hotel Manager/Head of Housekeeping
Property Manager
Interior Designer
Cleaning Company
Contractor
Other
Your Role to The Property
Email
Cell #
Please Select
Please Select
Email
Call
Text
Preferred Method of Contact
Telephone #
If you opted for SMS text, do you agree to receive text for new inquiry?
Please Select
Please Select
Yes, I agree to receive SMS text. I am aware that charges from cell company may apply.
No I don’t agree to receive SMS texts.
15
Timeframe Desired?
Urgent/ASAP
Immediate (within 2 weeks)
Within next 3 months
Next 3 to 6 months
No Rush/Any time available
16
How Did You Find Us?
Google
Facebook
YouTube
Instagram/Tweeter
Referral
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