Appointment Request - Customer Portal

Blankenship PCS: Act Fast!

Secure your spot! Experience the Blankenship PCS difference.

First Name

Last Name

Email Address

Phone Number

Address

City

State/Province

Postal Code

How did you hear about us?

Please select the size range that best describes your project area.

Briefly describe the goal of your project (optional)

What is your preferred start date for project? (REQUIRED FIELD)

Please specify if there is a specific date by which the project must be started or completed. Provide the date(s) below. (optional)

Select the service(s) you are interested in. (REQUIRED FIELD)

Polished Concrete

Sealed Concrete

Solid Color Epoxy

Flake Flooring

Metallic Epoxy

Epoxy Quartz

Other (Please specify below)

Could you detail any particular project requirements or logistical considerations we should account for, such as preferred scheduling, sensitivities to certain materials, or any access difficulties, including narrow passages, steps to elevated areas, side-only entrances, steep slopes, or other specific site conditions? (REQUIRED FIELD)

Form completion requires uploading current floor condition photos.

Notification Consent

I agree to receive text messages from Blankenship Polished Concrete Services, LLC.. These messages may include project-related updates, appointment reminders, and other important project-related information. You understand that standard text messaging and data rates may apply. You may opt out of receiving these messages at any time by replying "STOP" to any text message, or by contacting Blankenship Polished Concrete Services, LLC. directly.

Accepting SMS terms and conditions is required.