Online Order Form

HD Supply Account # (required for HDS Billing)

Property Name*

Date*

Phone*

On Site/Maintenance Phone #

Fax

Address*

City*

State*

Zip*

Email Address*

Resurface Color*

Occupied (Yes/No)*

Repairs (Yes/No)

Carpet Being Replaced (Yes/No)

Vinyl Being Replaced (Yes/No)

Notes (Parking, Building Access Codes, Special Details, Repairs, Warranty Work?)

Add Service*

Description	Price	Qty	Unit #(s)
Occupied Unit Service Charge - Kitchen	$
Occupied Unit Service Charge - Bath	$
Environmental Recovery Fee (Mandatory)	$

Customer agrees to RedRock 2 Year Warranty Terms and Conditions/Will have tenant sign Tenant Care Agreement If vinyl is new, Fridge/Stove will be removed prior to appointment. If not & vinyl tears, RedRock is not liable Bid excludes any unforeseen circumstances or conditions/Pricing subject to change All repairs (missing laminate, fiberglass, chips, etc.) are cosmetic and are not warrantied. Bathmats void warranty Standard RedRock Resurfacing/HD Supply billing applies - Less than 24 hour/Same Day cancelation results in $106 charge Edge of Resurfacing must be caulked 24 hours after application. Failure at edge of resurfacing not warrantied Our techs protect the surrounding areas but coatings do produce dust, some of which will be left behind Hand applied finishes - color, pattern and pattern size will vary

I have reviewed terms of service: Terms of Service

Please Sign Below to Authorize RedRock/HD Supply to Place the Order and Agree to the Terms Above

Printed Name *

Date *