MR FIX IT NOW.com

Tel: (714) 638-8991 Fax: (714) 638-8600

Please complete and submit the request below.

**PLEASE CALL OR FAX**

**IF NO RESPONSE WITHIN 24 HRS.**

Date Job to Start

Date Job to be Completed

Owner/Billing Information

Owner's Name:

Owner's/Your E-Mail Address:

Billing Address:

City: State: Zip:

Owner's Phone number: Owner's Fax number:

Manager Information

Manager's Name:

Manager's Address:

City: Zip-

Manager's Phone: Manager's Fax:

Information regarding property where work to be done

Owner or Tenant Name:

Owner or Tenant Address:

City: Zip:

Day Phone: Night Phone:

Work Order Information

Is this to be a : Work Order Estimate*

Work to be done: (Please be clear and specific)

1.) 2.) 3.) 4.) 5.) 6.) 7.) 8.) 9.) 10.)

Name of contact and best time to confirm work/estimate order:

Customer Number: Customer Authorization:

* There is a minimum $40 charge for all estimates which will apply to your invoice if work is done by MR FIX IT NOW.com

"One Call does it all - Day or Night, We'll Fix it Right!"

Satisfaction Guaranteed!

MR FIX IT NOW.com d.b.a. of United California Financial Corporation, a Licensed General Contractor #772226

California State Contractor's License Board (916) 255-3900,3132 Bradshaw Rd., Sacramento, CA 95827