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First Name

Last Name

Phone *

Email *

What is the approximate age of your roof?

Less than 5 years

5–10 years

10–20 years

Over 20 years

Not sure

What type of roof do you currently have?

Shingle

Tile

Flat

Metal

Not Sure

What’s your main reason for considering a new roof?

Storm damage / leak

It’s old / time for an upgrade

Insurance claim

Preparing to sell home

Interested in rebate offer

OTHER

How soon do you need a new roof?

Immediately
Within 1-3 months
Within 3-6 months
> 6+ months
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Long-Term Plans

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