Please print out and complete this form, then fax it to 913-727-5558 or mail to

A & A Roofing & Siding LLC
608 N Main 
Lansing, KS 66043

You may also copy & paste this form into a new e-mail message, then replace
the blanks with your answers and send it to

<sales@aaroofingllc.com>.

First Name:  _________________   Last Name: ___________________

Street Address:

________________________________________________

City: __________________________________ 
State: ___   Zip: ________

Daytime Phone: _________________  
Evening Phone: _______________

Cell Phone: _________________   Fax: _______________

E-mail Address:

_______________________________________________

Best Way to Contact You: __ day #   __ eve #   __cell #   __

fax   __e-mail

Best Time (s) to Contact You:

___________________________________

Roof Type:   __Wood   __Composition 
__Other (specify: _______________)

Any comments, requests or other information we need to know in estimating your job
(attach additional pages if needed):
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________