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Required fields are labeled in red.
__First Name__________------------___Last Name
Mailing Address
City -- --- -- State ----- Zip Code
Home Phone ---- Work Phone
Email
When is the best time to reach you?
How did you hear about us?
Referral Post Cards Arch./Design Eng.
Home Show Past Client Mail/Newsletter
Truck Sign Yellow Pages Web Site
Job Site Sign TV Ads
What type of remodeling do you need?
Whole House Kitchen Room Addition
Commercial Bath Hot Tubs & Decks
Painting & Flooring Windows & Doors Basement Finish
Other
Do you own the house?
Yes No
How long have you lived in the house?
Moving In 0-5 yrs. 6-10 yrs. Over 10 yrs.
What is the approximate age of the home?
What did you have done?
How well did it go?
went well bad experience
How much have you budgeted for or plan to invest on this project?
( 20k, 30k, etc.)
Would you like information on financing?
How soon would you like this project to begin?
0-4 months 6-8 months 8-12 months
Are there any upcoming events to plan around or consider?
Do you have working drawings or blueprints?
Have you talked with other professionals?
Describe Remodeling & Design Needs?
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