Service Request Form


Date:

Name:


Address:




Email Address:


Daytime Number:


Evening Number:


Best time to call:


Job Description:



Estimated Budget:


Timeframe to Start:


How did you hear about us?:



HOME REFERRAL SOURCE DISCLAIMERS

HOME REFERRAL SOURCE IS A DIVISION OF PREMIER PROPERTY SOLUTIONS, LLC.

HOME REFERRAL SOURCE PROVIDES CONTRACTOR REFERRALS. HOME REFERRAL SOURCE IS NOT LICENSED TO PROVIDE CONSTRUCTION SERVICES.

ANY SERVICES PROVIDED BY CONTRACTOR REFERRALS TO YOU ARE NOT UNDER THE CONTROL OF HOMEREFERRALSOURCE.   HOME REFERRAL SOURCE MAKES NO REPRESENTATIONS OR WARRANTIES, EXPRESS OR IMPLIED, WITH RESPECT TO SUCH SERVICES NOR DOES HOME REFERRAL SOURCE GUARANTY OR IN ANY WAY VOUCH FOR THE QUALITY OR COMPLETENESS OF ANY SUCH SERVICES.

IN NO EVENT SHALL HOME REFERRAL SOURCE BE RESPONSIBLE OR LIABLE TO YOU OR ANYONE ELSE FOR ANY LOSS, INJURY OR DAMAGE CAUSED IN WHOLE OR IN PART BY SERVICES, PRODUCTS OR INFORMATION PROVIDED BY CONTRACTOR REFERRALS.  WITHOUT LIMITING THE FOREGOING, HOME REFERRAL SOURCE SHALL NOT BE LIABLE FOR DAMAGES RESULTING FROM SUCH SERVICES OR ANY INCIDENTAL, PUNATIVE OR SPECIAL DAMAGES, OR FOR LOST PROFITS OR REVENUES, EVEN IF ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.

DO YOU AGREE WITH THESE TERMS AND CONDITIONS?

I Agree I disagree


Do you know of a contractor that we should have in our network? If so, type their name(s) and number(s) into the addtional Comments field above.