Name: {formtext}
Address: {formtext}
{formtoggle: name=Homeowner?; default=no}Caller is the homeowner{endformtoggle}
Phone: {formtext}
Email: {formtext}
Referred by: {formtext}
Ask things like:
- When did the issue begin?
- How long has the issue been occurring?
- Can you tell me more about the issue you are experiencing?
{formparagraph: name=Concern:; cols=45; rows=8}
Approximate Age of Equipment: {formtext}
Explained diagnostic of {formmenu: $110, customer approved.; $199 (OT), customer approved.; N/A - Diagnostic Waived; default=}
{formtoggle: name=Explained pricing for repair will be given once on site diagnostic is complete.; default=no}Explained pricing for repair will be given once on site diagnostic is complete.{endformtoggle}
Customer to pay by: {formmenu: Cash; Check; Card; Bill Out; default=}
SCC Member? {formmenu: Yes - 15% Service/3% Install Discount; No - Not interested at this time.; No - Not interested at this time, advised to visit website for special offers/financing info.; N/A - Commercial\ ; default=; multiple=no}
{formtoggle: name=Pets in home?; default=no}PETS IN HOME. Asked to secure prior to our arrival.{endformtoggle}
{formtext: name=Day; cols=15} - {formtext: name=Date; cols=10} - {formtext: name=AM or PM?; cols=10} ({formtext: name=Initials; cols=10})