Name and Job Address: First Name Last Name Street Address City State AK AL AR AZ CA CO CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip Code Phone: Home Phone Work Phone Cell Phone Best time to call: Mornings 8am-Noon Afternoons 12-5pm Anytime Email: Roof Information: Are you the owner? Yes No--I'm a potential buyer No--I'm a realtor No--I'm a manager or contractor No (Other) Is your roof leaking? No Yes What type is your current roof? Choose one 3-tab shingles Composition shingles Torch down (flat roof) PVC (flat roof) Hot Tar (flat roof) Metal roof Cedar roof Tile Combination of different roofs Not sure What is the age of your roof (give your best guess)? Choose one 0-5 years old 5-10 years old 10-20 years old more than 20 years old Not sure When was your home built? What type of roof do you want? 30 yr Laminated Composition 40 yr Laminated Composition 50 yr Laminated Composition Torch Down PVC Not Sure Describe your roofing needs: Optional Information About Your Roofing Project: How did you hear about us? Choose one Repeat Customer Radio ad Google search Craigslist Billboard Yellow pages Raynproof vans/containers DexOnline GSBA Angie's List Repeat customer Job signs Referred by friend or neighbor How steep is your roof? Choose one Flat Low slope Walkable Steep Very Steep Flat and steep mixture How many layers of roofing are on your current roof? Choose one 1 2 3 4 Not sure When do you plan to do the roofing project? Choose one Immediately In 1 to 2 months In 3 to 6 months What are your future plans with your property? Choose one Plan to stay for 15 to 20 years Plan to stay for 9 to 14 years Plan to stay for 5 to 8 years Plan to stay for 1 to 4 years Plan to move ASAP Which payment option are you interested in? Choose one 6 months Same-as-Cash financing (o.a.c. for homeowners) 3 months Same-as-Cash financing (o.a.c. for homeowners) Personal or business check Please leave this field empty: Please leave this field empty: