Click & Fix USA

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Plumbing & Electrical

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AC (HVAC services)

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Window Replacements

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Home Service Request

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Phone

Email Address

Street Address, Zip Code

Service TypePlumbing & ElectricalKitchen & Bathroom RemodelsRoofing ReplacementsAir Conditioning (HVAC services)CleaningPaintingCarpet & FlooringWindow ReplacementsGarage Floor & Garage Door ServicesLandscapingSolar PanelsRing & Cameras (Home Security Systems)Screen (e.g., window or porch screens)

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Preferred Service TimeMorning (8 AM – 12 PM)Afternoon (12 PM – 3 PM)Evening (3 PM – 6 PM)

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Name *

Phone

Email Address

Street Address, Zip Code

Service Type *Plumbing & ElectricalKitchen & Bathroom RemodelsRoofing ReplacementsAir Conditioning (HVAC services)CleaningPaintingCarpet & FlooringWindow ReplacementsGarage Floor & Garage Door ServicesLandscapingSolar PanelsRing & Cameras (Home Security Systems)Screen (e.g., window or porch screens)

No bankruptcies in the past 3 years? *YesNo

Current on mortgage payments? *YesNo

Late property taxes in the past 3 years? *YesNo

Are you the homeowner? *YesNo

SSN *0 / 11