Chimney Top Mount Cover Request Form

"*" indicates required fields

Name*

First Last

Email

Address

Street Address Address Line 2 City State ZIP Code

Phone

Purchase Order Number

Material

Stainless

Steel

Powder Coated Black?

Yes

No

Screen Height (inches)

8"

10"

12" (standard)

14"

16"

Other

Cover Notes

Lid Overhang (inches, measured from screen to outer edge)

2"

5" (standard)

Other

If Other, how many inches?

Width of the base of screen (shorter side in inches)

Length of the base of screen (longer side in inches)

Additional Information

Consent*

I agree to the privacy policy.

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If you need a chimney cover request form, we can answer your questions when you contact us.

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630 Trolley Blvd
Rochester, NY 14606

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Monday-Friday
8 AM – 5 PM

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