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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?
   Yes   No
Type of project

Roofing Project - New Construction
Re-roofing Project
Roofing Repair/Restoration
Preventative Roofing Maintenance
Vinyl Siding
Replacement Window(s)
Skylight(s) / Roof Windows
Door(s)
Trim
Gutters / Downspouts
Ventilation
Other

Are you the original owner?
   Yes   No

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

*

Is picture of the issue available?   Yes    No
Please attach a picture of the issue.



Is original Estimate available?   Yes    No
Please attach the original Estimate.



Is original Invoice available?   Yes    No
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
   Yes   No

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?
   Yes   No

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?
   Yes   No

Are you currently waiting on the results ofa COVID-19 test?
   Yes   No

By signing this form I acknowledge that, if issue is not covered under warranty a technician fee of $250.00 plus tax will be charged.

Authorized by:
Signature:

*




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