New Customer Form – Chimney Manns

Chimney Manns

* Chimney Cleaning *Inspection *Repair

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Repair Services
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New Customer Appointment Form

See Chimney Cleaning & Inspections for service details.
- Chimney Cleaning & Written Inspection - $260/flue plus tax one story house, $295/flue plus tax two story house.
- Written Chimney Inspection only - $220/flue plus tax one story, $255/flue plus tax two story.
Scheduling Information: Save $20 off our normal prices above by scheduling here online rather than calling. You will be contacted within 24 hours Monday-Thursday, 8am-4pm by email. We have limited appointments until the fall months.
Name*
First Last
Chimney Address*
Street Address City State ZIP Code
Contact phone number*
Email*
Chimney Directions
Chimney address & directions from a main road & city i.e. from Rice lake take 53....
Service Information
What's venting up the chimney flue you want cleaned and/or inspected?*
Is there a second system you also want serviced?
Third system?
What service are you looking for?
- Chimney Cleaning & Inspection.
- Chimney Inspection Only.
When was system last cleaned?*
Repair Estimate
Please describe the type of repair that your looking for. We do charge our inspection fee for repair estimates. We will not estimate a repair until the entire burning system is inspected. That takes time and we do charge for it.
Approx. age of home*
Height of home*
Comments?
Mailing Address if we are invoicing other than chimney address.
Where did you hear about us?*
Is this a real-estate transaction?*
- Yes
- No
Who is the "Responsible" party for payment and signing report?
Are you the buyer, seller or real estate agent?
- Buyer
- Seller
- Real estate agent
Who will be meeting us if anyone?
Comments, Questions
If payment is not provided at time of service where should we send the report and invoice?
Who does the Responsible party give us permission to talk with about report?
Would you like a text when we're 10 minutes from your home?*
This gives you a heads up that were on our way and just about to arrive at your location.
- Text
- Not needed
Does house have metal roof?*
- Yes
- No

Chimney Manns

Chimney Manns LLC | Shell Lake, WI 54871

New Customer Appointment Form

Service Information