Contractor Type *

Please select the type of customer that best describes you:* *The following information helps us improve our quality of service and ensures the accuracy of your information. Thank you for shopping with us*.

Roofing Contractor

Siding Contractor

General Contractor

Your Name *

First Name

Last Name

Company Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Office Phone Number *

(###)

###

####

Have you purchased from us before? *

Yes

No

Please select your preferred shopping location. *

Hammond, IN - 920 150th St

Chicago, IL - 6830 S. Cottage Grove Ave.

Portage, IN - 6455 Melton Rd

Biloxi, MS - 211 Magnolia St

How did you learn about shopping with us? *

Returning customer

Contacted by a Sales Rep

Internet Posting (Facebook, Craigslist, etc)

Billboard Advertisement

Personal Referral

Other (please expound below)

Delivery Policy *

View our delivery policy: Click Here

By checking this box I affirm that I have read and accept the delivery policy.

Communication & Promotional Preferences *

Check all that apply. Permission for representatives of Ray's Roofing Supply to contact me via the method(s) selected above has been granted by the undersigned.

Call

Text

Email

Prefer not to receive promotions

Are you interested in our Loyalty Rewards program? *

Yes

No