REQUEST FOR INSPECTION (Step 1/3)

 

 

COMPLAINANT:        Date______________

 

Name ___________________________________________ Telephone ____________________

 

Address ________________________________ City ___________________Zip ____________

 

JOB LOCATION:

 

Contact ___________________________________________ Telephone __________________

 

Address ________________________________ City ___________________Zip ____________

 

INSTALLING DEALER / CONTRACTOR:

 

Name ___________________________________________ Telephone ____________________

 

Address ________________________________ City ___________________Zip ____________

 

JOB INFORMATION:

 

Date of Installation  _________________ Type of Building: Residential ______________

         Commercial _____________

New Construction  ________________    Apartment ______________

Industrial _______________

Replacement Job ________________    Other __________________

 

Area Involved ___________________________________ Approx. Size (sq.ft.) _____________

 

Type Of Wood Floor Covering: Manufacturer’s Name (if known) ____________________

 Engineered  ________

 Solid   ________ Inspection By Other Parties:

 Laminate ________   Installing Dealer/Contr. ____________ 

       Manufacturer   ____________

       Other    ____________

NATURE OF COMPLAINT: use additional sheets for further explanation as required.

 

 

 

 

 

CORRECTIVE ACTION ATTEMPTED (if any): use add. sheets for further explanation as

REQUEST FOR INSPECTION (Step 2/3)

 

CHOOSE INSPECTION (mark one):

  

 Standard Inspection    (Verbal Report)       

 $295.00 plus applic. charges*

 

This report is used to find out what the nature of the problem is. It is best suited when the parties are not adversarial.

Note: you can upgrade to FULL later.      

 

 

 

 

  Full Inspection

(Written/ Narrative Report)

 

$795.00 plus applic. charges*

 

This report is usually generated after there where unsuccessful attempts to resolve the issue and chances are that the report could be used in Contractors State License Board proceedings or in court litigation.

 

*additional charges are: 

-telephone testimonials: $150/hr-in court testimonials: $1500/day

-mileage outside local area: $0.60/mile 

-revisions and or clarifications of existing reports: $150/hr

-any other applicable expenses such as parking fees, tolls, phone charges, postage, handling etc. 

 

 

Signed: 

 

 

_________________________________________

 

(COMPLAINANT)

Credit Card Authorization (Step 3/3)

 

Date: ______________________  Number of Pages Including This Page:______

 

Attention: ____________________  Phone:______________________________

 

Thank you for your order!  Please review the attached work order(s) for accuracy and indicate your approval by initialing each circle.   Then complete and sign the credit card authorization below and fax it back to us at (310)839-1449.

 

If you have any questions call ________________________ at (310)839-9663.

 

I authorize Universal Hardwood Flooring & Moulding, Inc. to:  (Place a check mark in the appropriate box(s).

 

 Charge the credit card listed below for payment in full of attached order(s).

 

 

OR

 Use the credit card listed below as a guarantee of payment only.   The credit 

 

 card listed below will not be charged if another form of payment is made when 

 order is picked-up/delivered.

 

ALSO

 

I authorize Universal Hardwood Flooring & Moulding, Inc. to keep this form on file for payment on future orders.

 

    NO    YES  Initials ___________

 

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CREDIT CARD AUTHORIZATION

 

Circle One: VISA   MASTERCARD   AMEX   DISCOVER

 

Account Number:  ________________________________________

 

Expiration Date:  _______________

 

Name on Card:  _________________________________________________

 

Authorized Signature:  ______________________________________________

 

 

Form will be kept in secure area with limited access.