Restore LA

We offer services for companies, groups and individuals.

The Restore Louisiana Homeowner Assistance Program is dedicated to helping homeowners affected by the March and/or August 2016 floods to repair and restore their damaged homes, or get reimbursement for work already completed.

Choice Sheet Selections:

* Please note - images may appear differently on the screen than in real life. Please make your selections and fill out the form below.

CHOICE SHEET SELECTION FORM

Please complete the form below to make selections for your home.

Contact Us

Full Name

Email Address

Phone Number

ID:

Address:

Flooring (Living Room)

Flooring (Bedroom):

Cabinets (Kitchen):

Cabinets (Bathrooms):

Countertops:

All Rooms Paint Color:

Trim/ Doors Paint Color:

Siding Color (Exterior):

Stucco Color (Exterior):

Soffit/Fascia/ Trim Color:

Kitchen Appliance Color:

ADA Bathroom Location:

Doctor's Note Provided?

Driveway Location:

Water Supply:

Sewage Waste:

Sewage Waste Company:

Septic Tank

Septic Tank Location (if applicable):

Sewage Treatment Tank Needed?

Electric Company:

Gas Company:

Opt-In

By checking the box I understand - the above selections are the selections that the above homeowner has picked to be installed in their house for the Restore Louisiana Program. These materials will be economic grade materials that comply with the program requirements.

Signature -Homeowner' s Signature - by typing my name below I agree that this shall be an electronic representation of my signature when I use it to sign this document - just the same as a pen - and - paper signature. Electronic Signature:

Restore LA

We offer services for companies, groups and individuals.

Choice Sheet Selections:

Flooring: Gray

Flooring: Dark Brown

Flooring: Light Brown

Carpet: Honey Beige

Carpet: Flax Beige

Cabinet: White

Cabinet: Espresso

Cabinet: Gray

Countertop: White Carrara

Countertop: Milano Quartz

Countertop: Milano Amber

Paint: Alabaster

Paint: Natural Linen

Paint: Navajo White

Siding: Tuscan Clay

Siding: Monterey Sand

Siding: Platinum Gray

Siding: Glacier White

CHOICE SHEET SELECTION FORM

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CRSC, LLC