Company Name:

Contact Name:

Contact Phone Number:

Contact E-mail Address:

Job Address:

Job City:

Job State:

Job Start Date:

Interior Work
(please enter "none" if there is no interior work ):

Exterior Work
(please enter "none" if there is no exterior work ):

Pre-written Specifications:
(If yes, please provide copy of job specs to our office prior to proposal submission )

--------------------- yes no

Liquidated Damages Apply?:
(If yes, please provide amount per day and proposed job schedule in the "Additional Information" field below. )

--------------------- yes no

Preferred Paint Supplier:

--------------------- Dunn Edwards ICI Dulux Kelly Moore Sherwin Williams Any Other

(If other, please specify):

Additional Information: