Note: All work is performed by Co-op members 
who are approved service providers for 
The Canadian Renovation Funding Program

To review information
about Pricing, click here

First Name:

Last:

Main Intersection:

Co-Owner's First Name:

Last:

and
Address:

City:

Best time range to call:
Province:
Between

and
Postal Code:
Home Phone:

Best Number:

Cell Phone:

Email Address:

How did you hear about us?

Talk 640 AM

Booklet

Other

Retail Store:

Retail Code:

Other:

CFRB AM

Private Referral

Billboard

TV Ad

Internet

Local Paper

Flyer

Home Advantage Club

Select Type of Work:

Approx Budget:
Job #1

Describe Other:

Job #2

Describe Other:

Please provide the following information:

Type of Home:

Detached

Semi-Detached

Townhouse

Condo

 Other

Approx. Age of Home:

Less than 10 Years

10-20

20-30

30-40

40-50

More than 50 yrs. old

Exterior:

Brick

Aluminum or Vinyl Siding

Combination
of both

Other

How old is kitchen?

1-2 years old

2-5 years old

5-10 years old

10-20 years old

Older than 20 years

Basement:

Is there any visible
water damage?

Is there an existing
separate entrance?

Yes

No
Yes No

Will you require financing?

yes

no

I'm not sure

Note: Please help us avoid "telephone tag" by indicating a range of time when you will be at a specific number.
Best time range and phone number to call:

Comments

Note: Please give us as much information as possible regarding your request. 
By taking out this time now you will help us to determine your needs and  
serve you quickly!

m

Please Note: It can take up to one minute for this form to submit. If you do not see a confirmation page within that time, please contact us directly at 416-367-8370