SPACE-FRAMES ORDER FORM (to be printed out and mailed or faxed in)

Name:

_____________________

Name:

_____________________

Address:

_____________________

Address:

_____________________

City:

_____________________

City

_____________________

State & Zip:

_____________________

State & Zip

_____________________

Home Phone:

_____________________

Home Phone:

_____________________

Office Phone:

_____________________

Office Phone:

_____________________

Fax:

_____________________

Fax:

_____________________

E-mail:

_____________________

Preferred Delivery Date:

_____________________

JOB SITE INFORMATION

State:_______________

_____________________________________________

Building Jurisdiction: (county, city, township)

_____________________________________________

Contact Name, if different than above:

_____________________________________________

Contact's Telephone Number:

_____________________________________________

Intended use for Space-Frames:

_____________________________________________

Moisture/Humidity Conditions:  Is the site near the ocean, lake or highly wooded area?

_________________________________________________________________________________________

Insect Conditions:  Are termites or carpenter ants a known problem in the area?

_________________________________________________________________________________________

Is there anything else you would like to add?

_________________________________________________________________________________________

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