3-A Construction, LLC. CCB #167959

New Customer Intake

Step 1 of 8 Contact Information

Please fill out this form to help us prepare an accurate estimate for your manufactured home installation. All information provided will be kept confidential.

Contact Information

First Name *

If couple, put both first names

Last Name *

Additional Customer Name

Optional - if there is another person on the account

Phone *

Phone 2

Optional secondary phone

Email *

Email 2

Optional secondary email

Property Information

Mailing Address *

Work Performance Address *

Enter the address where the home will be placed. Can also be a tax lot, assessor's map number, or tax account number if no street address exists yet.

Location Information

Jurisdiction *

City County

Rule of thumb: If you have Water/Sewer you are in City. If you have Well/Septic you are in County.

Home Specifications

Number of Sections *

Single Wide Double Wide Triple Wide Other

Width (feet)

If unknown, leave blank

Length (feet)

If unknown, leave blank

Additional Information

Comments/Questions

Any additional information or questions about your project

Review Your Information

Please verify everything looks correct before submitting.