Midwest Construction Company
Customer Information form

Midwest Construction Company Customer Information form
Your Name *
Your Email Address *
Phone number *
Address *
What type of work do you need done? *	Roofing   Siding   Windows   Gutters   Deck   Addition   Bath   Kitchen   Lawn   Snow Plowing   Insurance Repair   Water Mitigation   Other
when would you like to have the work completed by? *	Asap   within 1 month   1-3 Months   3-6 Months   other
Do you have specific plans/colors/optons in mind already? *	Yes   Somewhat   Not really   I would like to know what options are available
what research have you done on this project so far? *
What is most important to you on this project? *	Budget   Timeline   Quality
*
Where did you get our Number from? *	Yellowbook   Verizon phone book   Homepages phone book   Internet   Trucks   Billboard   Friend   other
Where did you first hear about us? *	Yellowbook   Verizon phone book   Homepages phone book   Internet   Trucks   Billboard   Friend   other

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Midwest Construction is an award winning remodeling and restoration company. We appreciate your interest in getting quality work done and we will get back to you shortly to schedule a time to meet with you.