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MID -STATES HOME DOCTORS, INC, 1515 Portage Avenue ; South Bend, Indiana 46616 Phone Fax 233-3348 287-7/751 Name: �vr� )JiCri� Date:t— Address: Ltl/�y` >-r. City: �' �� State: % Zip: Billing Address: Res. Phone: Z.33 9 �{. Bus. Phone: Insurance Company: ' Ins. Phone: Insurance Adjuster: Claim #: RECOVER / REPLACE ALL / PARTIAL AREAS: �'SIbI G• Brand: Style: Color: 'ro 41aT_" _ Supplier: �- ,f6jF3D Style: V W q 1, 2-3 G r ❑ Vented FASCIA- Style: Al"' `»/" GUTTERS: Style: DOWNSPOUTS: VENTS: ❑ Vented Color. ❑ Dryer Color: VOther % G,,+b4, . C" Color: -ro 6�-,VX -'ZS-' Color: G. pia- 5144.1 ADDITIONAL INSTRUCTIO o DOW WRAPS: % b 'Color: RS: ❑ New: ❑ Existing: Door Wraps: Color: W,,tV00-<.r- te.trliP�c PAYMENT TERMS: 1JP°�rU We hereby propose to,furnish labor andateriais in accordance with the specifications herein for the sum of- S Alt checks must be mad payable to�ID-STATES HOME DOCTORS, INC. THE kJRCR'gSER Aq*NOWLED�S: t , `1. That he or -she has read -this contract.-hamreceived a copy of this 6. Labor Warranty does not include damage to roofs or siding caused by agreement,`i�d agrees -tat it is a legal�d binding contract pro- tightening, gale (50 mph) force winds, hurricane, tornado, hailstorm. vided that thj provisions of the speciaNCstructions are met. impact or foreign objects, or other cracking to the roof deck due to 2. Replacement of deter�prated decking, ia,boards, roof jacks, settlement, distortion, failure or cracking to the roof deck, walls or ventilators, fiashingax other materials, unless otherwise stated, foundation of the building. This tabor warranty is non-transferrable. are not included and will be charged as n extra on a time and ?. All surplus materials belong to the company. Mid -States Home Doc - material basis. = c tors. Inc. Customers will supply electricity to perform the work. The J Any representations, or other commu cationsnot written in this company will provide all necessary building permits and perform_, contact are agreed to be immateriSl, a t no%jeiiedon by either all work in a workmanlike manner in accordance with job specifica- party, and do not survive the executn pf.t ' contract. tions. 4. Thepurchaser may canEcont-1l this coby1 ntractor receiving 8. This proposal will expire 60 days from contract date unless extended written notice at its ce prior to m ! it -Of the third business day in writing by the company. After 60 days, we reserve the right to after the date of this -contract. If matirilihs.td be reordered or re- revise the price in accordance with costs in effect at that time. stocked because of a2ancellation Y4customer, there will be a 9. Upon completion of the work, customer agrees to sign a completion rest tocking fee of fifteen percent (15"o f the contract price. certificate, or pay the balance of the contract. Purchaser hereby agrees that if the amounts due and owing here- 10. This contract is subject to final approval by the company. Mid -States un1fr are not paid when due. Pure r also shall be liable to pay all Home Doctors, Inc., and is the entire agreement. costs of collectiofi,lTtcluding buy n • 'mited to, reasonable attor- neys fee and costs which amounts, gether with all sums due and SER /( � (� owing hereunder,Mall bear interest. t 1 S90 per month. PCI JH�SEo Q �/ MID-STA'lyE� OME C. (date) t� � � � 7 (date) (Renresentative)�