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ORDER FORM
Who are you?
*
Homeowner
Builder
Realtor
Other
What brokerage are you associated with?
Company Name:
*
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Who are you representing?
*
Builder
Client
Do you have a builder?
*
Yes
No
NAME of Builder / Company
Do you have a client attached to this project?
*
Yes
No
Your Client's Name:
First Name
Last Name
Your Client's Email:
example@example.com
Your Client's Phone Number:
Please enter a valid phone number.
Responsible Billing Party?
*
Homeowner
Builder
Realtor
Other
Lot Information:
Lot Number:
*
Development:
*
City:
*
Address:
Are you referencing a VirtuActive plan or a Third Party Plan?
*
VirtuActive Plan
Third Party Plan
Plan Name:
Lot Number (if applicable)
If different from above
Development (if applicable)
If different from above
Address (if applicable)
If different from above
Builder
Third Party Plan Upload
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Choose a file
Please upload any third party plan you are referencing or email to Brittany at b.reinwald@virtuactive.com
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of
VirtuActive Standards:
Attic Insulation
*
R-38 (standard)
Other
Walls
*
2x6 exterior
2x4 exterior
2x6 Options
*
R-19 (standard)
Other
2x4 Options
*
R-15 (standard)
Other
Foundation
*
Finished
Unfinished
Windows
*
Double Pane Low E
Other
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