Customer ID

Name
Company (if applies)
Street Address
Address (cont.)
City
State
Zip Code
Work Phone
Home Phone
E-mail

Estimate Information:

Flyer  Post Card Received Written Proposal

Estimate Amount ($)

Scheduling Information:

Please call me to schedule the next available appointment.

I need the job done on a specific day or date:

Note: If you need your job done immediately please call us at 847-797-5683 to schedule the fastest available service time.

I will leave a check made payable to Seal-Kote Corp. taped to my front door the day the job is to be performed.

Please call to get my credit card information. Seal-Kote accepts Visa & MasterCard. Your card will not be charged until work is performed. (2% surcharge for credit card payments)

Do you think any of your neighbors would like to sealcoat their driveway on the same day as you? If you do and would like to receive a group rate please CLICK HERE.

Special Instructions:

You are only one click away from submitting your work order. I would like to take this opportunity to personally thank you for your business. Seal-Kote Corp. is constantly expanding thanks to you. Our goal is your satisfaction. If you have any comments on how we could better meet that goal please contact me personally.

Sincerely,
Larry Peiser
President