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Name: Street: Town: Zip Code: Home Phone number: Work Number: Cell Number: Fax Number: Email: Nearest main intersection: Check The Services In Which You Are Interested: Fireplace cleaning Furnace flue and  water heater flue cleaning Visual/video safety inspection Dryer exhaust cleaning Lining of a fireplace or  furnace chimney Installation of glass doors for the opening of the fireplace Firebox repairs for masonry and prefab fireplaces Protective chimney covers and bird screens Conversion from a wood burning fireplace to a gas log unit Mortar or brick repairs on the chimney Rebuild of the chimney Blockage Removal Smoke Problems Wood Burning Stove Cleaning Other, please explain: Check the most convenient day and time for an appointment: First Choice Monday AM Tuesday PM Wednesday Thursday Friday Saturday Second Choice Monday AM Tuesday PM Wednesday Thursday Friday Saturday Check the most convenient month: January July February August March September April October May November June December Best time and day to contact you to confirm the information and the appointment:

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