Registration Feed-Back Form

ROC LICENSE NUMBERS: 089573 082241 0947102 LOCALLY OWNED AND OPERATED SINCE 1982!

NEW CUSTOMER:

$25 OFF
GIFT CERTIFICATE
just register!

602-273-7473 | 623-925-8190 | 480-783-8367

NEW CUSTOMERS**/NEW VISITORS TO OUR WEBSITE**:
FILL OUT AND SUBMIT THIS FORM, AND WE'LL EMAIL/SEND YOU a
$25 OFF GIFT CERTIFICATE
VALID TOWARDS ANY PURCHASE OF PLUMBING, AC OR HEATING REPAIR OR SALE and INSTALLATION from STEVENS PLUMBING, HEATING AND AIR CONDITIONING, just for registering with us.

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                                     HOW DID YOU HEAR OF US? Please complete either Section 1), Section 2) or Section 3) below:

Section 1)

       A)   INTERNET SEARCH? (please make selection from dropdown menu, below)

       B) IN WHAT AREA of the SEARCH RESULTS did you see and respond to our ad?

PLEASE TELL US THE KEYWORD OR PHRASE YOU USED IN YOUR INTERNET SEARCH.

Section 2)

REFERRED? Please tell us by whom (type name in box below.)

Section 3)

OTHER SOURCE? (Please select one from drop down box, below)

WE WELCOME YOUR FEEDBACK:

MAY WE USE YOUR COMMENTS IN OUR MARKETING*?

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We respect your privacy. Your contact information will never be sold or shared, but will only be used by us to respond to your questions/concerns/requests and to contact you with future special offers we feel may be of interest and benefit to you. *If we use your comments in our marketing, your name will be changed
to protect your privacy. Thank you!

**New Customers only, please.