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Service Request

Online Service Request Form

You can fill out the online form below, or download a pdf version that you can send or fax. You can send the form to: ROEM Builders, Inc., 1650 Lafayette Street, Santa Clara, CA 95050. You can fax it to this number: (408) 984-3111

* required fields


Homeowner Name*

Community*

Address*

Lot No.*

Home Phone*

Second Phone

Email Address*

Date deficiency first discovered*

Description of work requested: