To receive the most accurate price quote, please take a moment to

complete this form. Or call us and we'll assist you over the phone.


To protect your privacy, your personal information will not be shared in any

way and will only be used to provide your estimate.


Day Phone:

City: , CA   Zip Code:

How did you hear about us?
Internet   Yellow Pages  Radio/TV  Other __________________

What type of work do you need?

Repair   Replacement


What type of door needs to be repaired / replace? Is it electrically operated?

What problems do you need repaired?
 Damaged Sections  Broken Springs  Broken door parts
 Worn out hardware  Rollers out of track  Bent or damaged tracks
 Cable off the drums  Door wonít close  Other
 Door wonít open  Door damaged, broken, dented, etc.
 Broken door parts  Gaps around door (bottom, side or top) when closed

What is the approximate size?
 Single car garage door  Double car garage door  Other

Do you want a garage door opener installed with your new garage door?
 No  Yes, new system installed  Yes, existing system re-installed
 Other  Donít Know

What type of Garage Doors are you interested in?
 Steel  Vinyl  Sectional  Plain glass panels
 Other  Aluminum  Fiberglass  Custom (wood application)
 Tilt- Up  Decorative glass panels  Masonite

Appointment: _______________________________________________________

Comments: _________________________________________________________