Leak Form: Amaya Roofing and Waterproofing

Leak Form: Amaya Roofing and Waterproofing
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Customer Details:
Name of Business (Where Leak is located):
Address (Where the Leak is Located):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Building/Unit #:
Gate Code (If Available):
Hours of Operations:
Point of Contact:

First NameLast Name
Phone Number
Format: (000) 000-0000.
Warranty?
Leak Description:
Roof Access Information (Gate code, Bring ladder, pick up key, etc.):
Upload Photos (If Available):

Cancelof
Are you interested in the Yearly Preventative Maintenance Program?
Company:
Requested By:

First NameLast Name
Email
example@example.com
Billing Entity:
Billing Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PO # (If available):
How did you hear about us?
TERMS: By me submitting the above information, please proceed with leak inspection/repair with a NTE $500.00 which includes our Minimum Service Fee of $350.00. If being reported as a possible warranty and after investigation it is deemed repair is not covered under warranty, by submitting the above information you are authorizing us to proceed with a NTE $500.00 repair, which includes our Minimum Service Fee of $350.00. Due to weather and/or repair size, I understand and acknowledge a temporary repair may be performed and I will be provided with a proposal for permanent repair. Payment on all NTE’s are payable NET 15 daysupon invoice. NO Warranty on all Emergency Leak Dispatch NTE’s.
NTE Amount (if over $500.00)
Signature
Should be Empty: