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Name
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Email
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Phone Number
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Improper Phone #.
Address of property in question
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Contractor Name
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Contractor Phone Number
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Contractor Address (if available)
Contractor License # (if available)
How did you hear about this contractor?
Neighbor
Internet
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Church/Civic Group
Other (Explain Below)
Briefly describe work that is being done
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What information are you requesting?
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