River City Referrals

Your Information

Your First Name
Last Name
Company (optional)

Your Address:

Project Address (If different):

City:
State:
Zip Code:

Business Phone:
Home Phone:
Mobile Phone:

E-Mail 1:
E-Mail 2:

Best Time To Call:

How did you learn about River City Referrals, LLC?

Repeat Customer
Realtor
Customer
Contractor
E-Newsletter
Existing Relationship (ex. Friend, Neighbor)
Internet Search/Website

Advertisement
Richmond Yellow Book
Clear Channel Radio
Post Card / Brochure
Local Tradeshow
BNI
Glen Gary
Other

Other:

Project Information

Briefly describe your project(s):

Time Frame to Start Project:

Immediately- within the next week

1-3 Months 3-6 Months 6-9 Months In the next 30 days

Other (explain)

What is the least amount you think you need to spend to complete your project?

I have read and accept the Terms of Agreement below

Terms of Agreement

I understand and acknowledge that River City Referrals, LLC, (hereinafter "RCR") is a referral service and will refer contractors who have been screened, consistent with RCR's program, to be considered by me to accomplish a job that I described in an online Work Request or to a representative of RCR. Any arrangements made, or contracts negotiated, are strictly between me and the contractor. I understand that the contractors referred to me are independent of RCR. RCR has not made any representation to me as to the work to be performed or the nature or quality of the work anticipated to be accomplished. I agree to satisfy myself that the contractor meets the standards of work I require. I hereby hold RCR harmless from any defect in workmanship, default, damage, injury or expense arising out of the work performed by a contractor referred by them and hired by me.

Thank You! We will be in touch promptly.

Call: 1 (804) 545-0822
Email: info@rivercityreferrals.com

*Privacy Policy: It is the policy of River City Referrals, LLC to protect your privacy.
The information that we request is used solely for your home improvement needs.
We will never sell, trade or lease your personal information.

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River City Referrals, LLC.
Phone: (804) 545-0822, E-Mail: info@rivercityreferrals.com