Chase Cover Builder Request Form - Owens Chimney Covers

Company Name*

Technician Name

Customer Name

Material

Style

Standard

Paint

No
Yes

If paint please specify color

Skirt (Measured in inches)

* Indicates our standard design

Collar Height (Measured in inches)

* Indicates our standard design

Storm Collar

No
Yes

If yes, please list size

Holes?

No
Yes

If yes, how many holes?

One
Multiple

If multiple holes, download the worksheet at the bottom of the page, mark down the placement of the holes and send to brian@owenschimneysystems.com. Or give us a call at 704-839-0329.

Will the hole be centered?

Yes
No

If not centered, please download the worksheet at the bottom of the page, mark down the placement of the hole and send to brian@owenschimneysystems.com. Or give us a call at 704-839-0329.

Please list the total width of the cover in inches (shorter side).

Please list the total length of the cover in inches (longer side).

Other Notes

Your Contact Email

Your Phone Number

Consent*

This checkbox symbolizes your virtual signature.

Name

This field is for validation purposes and should be left unchanged.