Customer Information
Please Fill In The Blanks Below To Better Assist Your Service Needs

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  *Customer Name:
  *Address:
  *Home #:
  *Alt.#:
  *E-mail:
  *Comments/Details:
  Interior:  One Story
 Two Stories
  Number of Rooms to Paint:
  Suerfaces to Paint:  Ceilings
 Walls
 Doors
 Trim
  Exterior:  One Story
 Two Stories
  Surfaces to Paint:  Trim
 Siding
 Doors
  Problems:
  Interested in Green Alternatives:  Yes
 No
  Have you Selected Paint Colors:  Yes
 No
  Request Stage:  Ready to Hire
 Not Ready to Hire
  Desired Completion Date:
  Type of Location:  Commercial
 Residential
  Property Owner:  Yes
 No

A EZ Painting Representative Will Contact you Shortly to Scheduule your Convenient Estimate Appointment THANK YOU
 
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