Department of Licensing and Consumer Affairs Plumbing Services and Supply Price Survey Form Name of your Business: ______________________________________ Business Physical Address: ___________________________________________ Telephone Number:____________________ Business Number: ___________________ Social Security No:_____________________ Tax I.D. No.: _______________________ Plumber ID Number:____________________ E-Mail: ___________________________ Legal form of Business: □ Corporation □ Partnership □ Partnership □ Joint Venture □ Individual ITEM UNIT LOW HIGH R/R Kitchen Sink Each $___________ $___________ R/R Garbage Disposal Each $___________ $___________ R/R Toilet Each $___________ $___________ R/R Lavatory Each $___________ $___________ R/R Bath Tub/Shower Each $___________ $___________ R/R Water Heater Each $___________ $___________ Plumbing Inspection and Estimate Job $___________ $___________ Total Plumbing System Replacement ITEM LOW HIGH R/R Economy $_____________ $____________ R/R Average Quality $_____________ $____________ R/R Good Quality $_____________ $____________ R/R High Quality $_____________ $____________ Over head* Include Insurance & Tax $_____________ $____________ Profits* $_____________ $____________ *Provide these figures only if they are not included in the unit cost. I hereby certify that the information provided herein is true and correct. _____________________________ _________________________ ________________ Print Name Signature Date