Please complete the following:
Your Name:
Address:
City:
State:
Zip:
Daytime Phone:
Evening Phone:
Fax:
E-mail address:
Best time to call:
Project
description
(please include as much detail as possible):
How quickly do you
want to begin the project:
No rush;
I'm flexible
Within 1 month
Within 1-3
months
Within 3-6
months
Other
How did you hear
about At Your Service Solutions?
Friend/Neighbor
Web search
Mailing
Advertisement
Word of mouth
Contractor
Realtor
I've
used your service before
Other
If referred by a friend or neighbor,
please include their name. If other, please
explain:
Please check the "Terms
and Conditions" box below before submitting
work request.
Terms
and Conditions
I understand and acknowledge that At Your Service Solutions, LLC is a referral service
and will refer contractors and/or service
professionals who have been screened, consistent
with At Your Service Solutions' prescreening
program, to be considered by me to accomplish
a job that I described to a representative
of At Your Service Solutions, LLC. Any arrangements
made, or contracts negotiated are strictly
between the contractor and me. I understand
that the contractors and/or service professionals
referred are independent of At Your Service Solutions, LLC. At Your Service Solutions,
LLC has not made any representation to me
as to the work to be performed or the nature
or quality of the work anticipated to be accomplished.
I agree to satisfy myself that the contractor
meets the standards of work I require. I hereby
hold At Your Service Solutions, LLC harmless
from any defect in workmanship, default, damage,
injury or expense arising out of the work
performed by a contractor referred and hired
by me.
I have read and accept these terms and conditions.
Thank you!