Full Name:        

Address(street):  

City:              
 
State:            
 
Zip.:             

Phone Number:     

Email address:    


What Kind of flooring are you interested in?

                                 CARPET WOOD TILE LAMINATE VINYL AREA RUGS OTHER 
  
        
If Other Specify:               


How many in your household? Children? Pets?      
                                 


What style of decorating is your home or business?

                                 MODERN COLONIAL VICTORIAN OTHER 
  
        
If Other Specify:               


Approximately how large is the area or areas 
that you are considering purchasing new 
flooring?                       
                                

What type of traffic and activity occur in the 
area(s)?
HeavyModerateLight

This area is best described as?
IndoorOutdoorBasementOther

If Other Specify:               

Have you purchased new flooring in the past 5 years?
YesNo

If yes where did you purchase it?            
B&DOther
If Other Specify:               

Are you satisfied with the way the flooring 
was installed?
YesNo

Did You get what you paid for?
YesNo