EDDIES WELDING

& FABRICATION

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    Please complete the following form to schedule an appointment with one of our representatives to discuss your needs, and to provide you with a free estimate.

NAME OF PRIMARY and/or SECONDARY CONTACT

LAST: FIRST:

LAST: FIRST:

PRIMARY PHONE: () - extension?:

SECONDARY PHONE: () - extension?:

FAX NUMBER: () -  

COMPANY:

ADDRESS STREET NAME AND NUMBER:

CITY: STATE: POSTAL ZIP CODE:

Is the previous address the site where our services are needed? YES NO

If the address and the worksite location differ please provide site address and/or driving directions below.

ADDRESS STREET NAME AND NUMBER:

CITY: STATE: POSTAL ZIP CODE:

OR

DRIVING DIRECTIONS FROM CLOSEST MAJOR INTERSTATE HIGHWAY (i.e. I-85 South)

Please provide a brief description of your project (i.e. handrails, stairs, custom fencing, etc.)

Is there a project deadline? YES NO

DATE:   20