PERSON INFO:	PROPERTY INFO:
Email Address
Property Management Group	Name of Property
Address	Address
City / State / Zip	City / State / Zip
Contact Person	Building Number / Unit Number
Phone Number / Fax Number	Contact Person / Phone Number
ROOF ASSEMBLY (IF KNOWN) Modified Bitumen Built-Up Roofing Tile Single-Ply Shingles
DESCRIPTION OF AREA OF WATER ENTRY
FREQUENCY OF LEAKAGE During All Rains During Driving Rains Only Periodically	EXTENT OF LEAKAGE Severe Moderate Mild
Work will be completed on a time and materials basis. I hereby authorize Roofing Concepts Unlimited/FL, Inc. to perform necessary repairs to the above referenced location not to exceed $ If repairs exceed this amount, I hereby Request a written estimate prior to any repairs being made; or I authorize temporary repairs not to exceed the above amount.
	Authorized by: Property Manager / Date