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Accurate Roofing Warranty & Service Authorization Form

Request Warranty Service

Please provide the following information:

Name
*
Company (if commercial)
Street address
*
City
*
State
*
Zip Code
*
Phone (Daytime)
*
Phone (Evening)
Fax
E-mail
*
Work completed date
Was work completed by Accurate?
     
Type of project













Are you the original owner?
     

Please use the text box below to provide a detailed description of the issue:

*

Is picture of the issue available?     
Please attach a picture of the issue.



Is original Estimate available?     
Please attach the original Estimate.



Is original Invoice available?     
Please attach the original Invoice.


Have you experienced any of the following symptoms in the past 48 hours:
fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea
     

Within the past 14 days, have you been in close physical contact (6 feet or closer for a cumulative total of 15 minutes) with:
Anyone who is known to have laboratory-confirmed COVID-19? OR Anyone who has any symptoms consistent with COVID-19?
     

Are you isolating or quarantiningbecause you may have been exposed to a person with COVID-19 or are worried that you may be sick with COVID-19?
     

Are you currently waiting on the results ofa COVID-19 test?
     

By signing this form I acknowledge that, if issue is not covered under warranty a technician fee of $350.00 plus tax will be charged.

Authorized by:
Signature:

*




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