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First Name:
Last Name:
Address:
P.O. Box or Apt.
City:
State:
Zip Code:
Phone (Day):
Phone (Evening):
Fax:
E-Mail:
Do you wish to meet with a Designer-On-Call? Yes
No
What spaces do you wish to address?
Living Room
Dining Room
Family Room
Master Bedroom
Bedroom
Bath
Kitchen
Nursery
Entry
Hallway
Office/Study
Stairway
Other
 
What change(s) or additions(s) are you considering? Furniture
Flooring
Carpets/Rugs
Window Treatments
Lighting
Wallcoverings/Paint
Developing a Floorplan
Accessorizing
Artwork
Plumbing
Re-upholstering Existing Pieces
Other
What are your specific objectives?
How many people will use the space and how often? (Children or Guests?)
What, if any, pets have access to the space?
What is the ideal time frame for your project? Immediate
Within 6 Months
6 Months to 1 Year
2-3 Years
Does your project involve construction? New Construction
Renovation
Addition
No Construction
Have you ever worked with an interior designer? Yes
No
If yes, was the experience successful?
What is your design style preference? Traditional
Transitional
Contemporary
Eclectic
Other
Is the setting formal or casual? Formal
Casual
Is the space used for entertaining? Yes
Occasionally
Not Really


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