Website Service Request Form

Builder Name

Unit #

*********Please Only enter the number no symbols*******

House #*

*********Please Only enter the number no symbols*******

Street Name*

If street name is more than one word type in without spaces eg. "West12th" or "OldNicolatrail"

Street Type*

Select or enter value

CITY*

SHOWROOM*

Please select one of the showrooms that is the nearest to your home address

Select

Service Contact Name*

Service Contact #*

Service Contact Email*

INITIAL PRODUCT SHIP DATE*

If you are unsure of your exact product ship date please estimate this date

NEXUS ORDER #

Issue #1Handing / Size*

Issue #1 Room / Floor*

Issue #1 Comments*

Issue #2 Handing / Size

Issue #2 Room / Floor

Issue #2 comments

Issue #3 Handing / Size

Issue #3 Room / Floor

Issue #3 Comments

Issue #4 Handing / Size

Issue #4 Room / Floor

Issue #4 Comments

Issue #5 Handing / Size

Issue #5 Room / Floor

Issue #5 Comments

General Comments

File Upload*

Drag and drop files here or

Send me a copy of my responses