REQUEST FOR CUSTOMER SERVICE

GHA ENTERPRISES, INC.
30-875 Date Palm Drive, Suite C-1, Cathedral City, CA 92234
Tel. (760) 969-1400 / Fax (760) 969-1417
After Hour Emergencies Only: (800) 657-0227

To help ensure attention to your request in a systematic and timely manner, please use this form for your service requests. Telephone requests cannot be processed unless of an emergency nature.

*DATE:
COMMUNITY:
*NAME:
*ADDRESS:
*LOT #
*PHASE #
*HOME PHONE:
*BUSINESS PHONE:
Item # Description of Request Date Completed Accepted Sign-Off
Please allow approximately sixty (60) days for completion of request.

NOTE: ANY FIELD MARKED WITH DOUBLE * IS REQUIRED INFORMATION. ANY CUSTOMER SERVICE REQUEST SUBMITTED WITH INCOMPLETE INFORMATION WILL BE RETURNED AND CAN CAUSE A DELAY IN COMPLETING YOUR CUSTOMER SERVICE ITEMS.

Further, by executing this Request for Customer Service, I agree to indemnify, hold harmless and defend GHA Enterprises, Inc., its officers, directors, employees, agents, and/or representatives from and against any and all claims associated with any third party entering my residence in my absence. This indemnification provision will not apply to the work performed on my residence pursuant to this Request for Customer Service.

I agree to the terms listed above and state all information entered in this form is true.