Custom Chimney Cap Worksheet Customer Chimney Cap Request Form Customer Name(Required) Email Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhonePurchase Order Number MaterialStainlessCopperOtherIf Other, which material? Powder Coated Yes No Choose ColorEnter Color Screen Height (Measured in inches) 8 in. 10 in. 12 in. 14 in. 16 in. Other Cap NotesLid Overhang (Measured from screen to outer edge of lid in inches) 2 5 Other If Other, how many inches? Lid StyleFlat/BasicHip/Ridge with Standing SeamsHip/Ridge without Standing SeamsOtherIf Other, which lid style? Horizontal Skirt (Measured in inches) 2 in (Standard) 3 in 4 in 6 in Other N/A Vertical Skirt (Measured in inches) 3 in (Standard) 4 in 5 in 6 in Other N/A Width of the base (shorter side in inches) Length of the base (longer side in inches) Additional InformationConsent(Required) I agree to the privacy policy.CommentsThis field is for validation purposes and should be left unchanged. Δ
