Derrick Blaine Homes Inc. - SERVICE REQUEST FORM

	Customer Feedback Survey
	New Home Customer Inquiry

First Floor:
At Derrick Blaine Homes we consider customer service very important. We want to make moving into your new Derrick Blaine Home an exciting experience. Please take some time to fill out the information listed below, and submit it to our service department. During the first year of possession, homeowners will have three opportunities to report warranty items. It is essential that homeowners use the Derrick Blaine Homes service request form and submit their 3rd month, 6th month and 12th month service request on time. It is also important that homeowners follow the instructions on the form to ensure that they are complete and are submitted on time.
Month*:	3rd Month 6th Month 12th Month
Homeowner Name*:
Address*:
Community*:
Possession Date*:
Home Phone*:
Work Phone:
Cell Phone:
E-Mail Address*:
Since moving into our new Derrick Blaine Home, we have noticed the following items. We understand that if the items requested are covered under our Derrick Blaine Homes Warranty, Your service department will address them as soon as possible. Explanation of Service Work Required
Second Floor:
Basement:
Exterior:
Instruction / Information:
* Required information that must be submitted