New Customer - Commercial Quote Request Form

Please completely fill out the form to request a commercial quote. All fields denoted by a red (*) are required

*Contact Name:
*Contact Phone:		OR	*Contact Email:

Service Requested

Leak Service Comprehensive Survey Quote for Repair/Maintenance Quote for New/Re-Roof

By the submission of this form the customer is under no obligation to contract with Heritage Roofing, Inc. This request will be sent directly to our Sales and Service Departments and you will be contacted within 24 hours. If your request is a roof related emergency, please call 717-377-7676 for immediate assistance.

Company Name:		Street Address:
Po Box:
City:		Zip:

Contact Name:		Contact Phone:
Fax:		Email:

Contact Preference

Phone Fax Email

Best Time to Contact

Morning Afternoon Evening

Proposal/Price Deadline:

Bid Date(if applicable):

Type of Company:

Contractor Owner Management Company HOA Other

Name:		Street Address:
City:		Zip:

On Site Contact:		Alternate Phone:
Scheduling Preference:

Building Type

Warehouse Office Retail Government Restaurant Hospital School Residential Other

Please describe building / site and any problem areas:

*Do you require a Purchase Order?
Purchase Order #:

Roof Access:

Roof Hatch Wall Ladder Other

If other please explain:
Age of Building:
Height of Building:

List any current or previous leaks reported and their approximate location(s):

Is Roof Under Warranty?

Yes No Not Sure

If so, Warranty Manufacture:
Year Roof Installed: