Win a Weber

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First name

First name

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Last name

Last name

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Email address

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Phone number

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Address

Address

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I agree with the terms and condition and I'm also happily subscribing to the newsletter.

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Are You a homeowner

1

Yes

2

No

Are you authorized to make changes?

1

Yes

2

No

Do you have plans for renovation?

1

Yes

2

No

What is the aim for your gutter project?

1

mco-43a9711b

Gutter Instalation

2

mco-2804a2db

Gutter repair

What is the nature of your request?

1

mco-e2ab54be

install/replace an HVAC Unit

2

mco-536e77a8

Repair an HVAC Unit

What type of system are you looking for or getting Installed/repaired?

1

Air condition

2

Other heating systems

What kind of heating system do you have today?

1

Furnace

2

Boiler/Radiator

3

Heat Pump

4

Do not know

What is the timeframe of your new bathroom?

What is your purpose for installing a walk-in tub?

1

Safety reasons

2

Therapeutic reasons

3

Other

What kind of flooring services do you need?

1

Install

2

Repair

3

Refinish

Which option best describes your flooring project needs?

1

Only Labor

2

id-8c7053c9

Labor and materials

What is the aim of your window project?

1

mco-c1104480

Window Replacemant

2

mco-0a51120a

Window repair

3

mco-fb50de87

New window installation

How many windows do you need to work on?

Do you seek to repair or replace your roof?

1

Repair

2

New Roof for an Existing Home

3

New Roof for New Home

4

Shingle over Existing Roof

What is your avarage monthly electricity bill?

How much sunlight does your roof get?

Do you have other renovation plans?

1

Yes

2

No

What kind of siding services do you need?

1

Install

2

Replace

3

Repair

Do you own a car?

1

Yes

2

No

Are you a Type I or II Insulin Dependent Diabetic?

1

Yes

2

No

Would you like to lose weight?

1

Yes

2

No

Would you like a free horoscope reading?

1

Yes

2

No

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Were You Stationed At Camp Lejeune, for at least 30 days between August 1953 and December 1987?

1

Yes

2

No

Did You Work With The Herbicide ParaQuat??

1

Yes

2

No

Did You Use Roundup Weed Killer at Home?

1

Yes

2

No

What was the type of motor Vehicle accident?

Date of Accident

Please select a date.

Who is legally At-Fault for the Accident?

1

Another Driver

2

I was Fault

3

Road/Weather conditions

4

Animal or Obstacle

Have you Recived Medical Treatement from a Doctor?

1

YES

2

NO

Are You Currently Represented by an Attorney in this matter?

1

YES

2

NO

Briefly Describe what Happened

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Enter the 5 digit Zip code of Where the Accident Occurred?

Enter the 5 digit Zip code of Where the Accident Occurred?

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THANK YOU

For entering the competition

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4K QLED TV

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