Customer Information

1. Customer(required)
2. Salesman(required)
3. Date
4. Name of Project
5. Job Address
6. City
7. State
8. Zip Code
9. Name of Contact
10. Phone#
11. Job #
12. Estimated Amount of Materials Needed
13. Permit #
14. Public Job #

General Contractor

1. Name
2. Phone #
3. Address
4. City
5. State
6. Zip Code

Owner of Project

1. Name
2. Phone #
3. Address
4. City
5. State
6. Zip Code

Property Owner

1. Name
2. Phone #
3. Address
4. City
5. State
6. Zip Code

Bonding Company (if applicable)

1. Name
2. Phone #
3. Address
4. City
5. State
6. Zip Code
7. Agent's Name
8. Phone #
9. Address
10. City
11. State
12. Zip Code

1. Is Job Taxable? Yes No
2. If Tax Exempt, what is the rate?

If this job is not taxable, this job form must be accompanied by a “Tax Certificate” or taxes must be charged. Please attach a copy of the Exemption from the Taxing Authority to this form with submission.