Note: Please complete this form as thoroughly as possible. Try not to leave any part unfinished. PERSONAL INFORMATION First Name Last Name Current Address City State Zipcode Telephone Email Neighborhood Referral Who are you referring? First Name Last Name Current Address City State Zipcode Telephone Email What service is needed? HandyMan ServicesRomodeling-Baths,Kitchens,Whole House,Disability RennovationsInterior And Exterior PaintingEstimatesSenior and Disabled Citizens Services Who should we send your payment to? HomeOther Would you like us to call you for service? YesNo Rules of the Program 1.The Company pays a maximum payment of 3% of the total price of the project upon our being paid. We don’t pay for referrals on time and materials projects or projects under $1,000. 2. We maintain no responsibility for reporting income to the IRS. We maintain no responsibility for reporting income to the IRS..By Submitting This Form You Agree to The Rules of the Program as Specified.