IMAGE GLOBE SERVICES
PROVIDING CUSTOM SERVICES AND INSTALLATIONS
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604-515-2306
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Client Direct Request Form
Client Installation Request Form
1
Service / Installation
2
Communication and Site Information
Shower Door Manufacturer
*
Brand
SHODOR
FLEURCO
KALIA
MAAX
ACRITEC
OTHER
OTHER - Please Describe or submit picture
*
Information on Door
*
Brand
Model
REQUIRE PRE-MEASURE
NO
YES
Note: For Free Pre-Measure this request must come from your Showroom Consultant
REMOVAL OF OLD DOOR
NO
YES
REQUIRE DELIVERY
NO
YES
Note: For Free Delivery this request must come from your Showroom Consultant
Name of Store where Door was purchased
*
Name of Agent / Consultant
First
Last
Phone
Email
Store Address
Street Address
Address Line 2
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
Please provide approximate Date for installation request.
DD dash MM dash YYYY
Message
File / Attachments / Pictures / Copies of Receipts / Invoice
Drop files here or
Select files
Max. file size: 64 MB.
Name
*
First
Last
Email
*
Enter Email
Confirm Email
Phone 1
*
Phone 2
Job Site Address
*
Street Address
Address Line 2
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
Hidden
Time
:
Hours
Minutes
Hidden
Date
MM slash DD slash YYYY
Comments
This field is for validation purposes and should be left unchanged.
