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Name
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Zip Code
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Telephone
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Email
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Type of Structure
Residential Garage
Residential Basement
Residential Other
Commercial Sales Floor
Commercial Storage
Commercial Other
Warehouse
Something Not Listed
Additional Info
Pre-existing Surface Stains (oil, fluids, etc.)
Uneven Surface with Scratches, Divots, Holes
Any Stairs Needing Coating
Raised Footings or Sidewalls (up to 6")
Tall Footings or Sidewalls (more than 6")
Excessive Cracks to Fill in Prep
Need to Remove Existing Coating
Water Damage or Bubbling Up
Desired New Surface
Solid Epoxy (with antislip)
Partial Flake
Full Flake
Length (in feet)
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Width (in feet)
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