Name
*
First Name
Last Name
Date
*
MM
DD
YYYY
Jobsite address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Cell Phone
*
(###)
###
####
Home Phone
*
(###)
###
####
Office Phone (Optional)
(###)
###
####
Email Address
*
How did you hear about us?
Check all that apply
Have you ever purchased a kitchen before?
-
Yes
No
When would you like to start this project?
MM
DD
YYYY
When would you like to complete the project?
MM
DD
YYYY
Has anyone assisted you in preparing a design for the project? If so, who?
Do you plan on retaining an interior designer or architect to assist you in the kitchen planning? If so, who?
Do you have a specific builder/contractor with whom you would like to work? If so, who?
What budget range have you established for your kitchen project?
-
$5,000 - $10,000
$10,000 - $20,000
$20,000 - $40,000
$40,000 - $60,000
$60,000 - $75,000
$75,000 - $100,000
$100,000 or more
How long do you intend to own the jobsite residence?
Are you considering relocating any of the following?
Check all that apply
In addition to the cabinetry, will you be adding new:
Check all that apply
How many people are in your household?
-
1
2
3
4
5
6
7
8
9
10+
Do you plan on having an eating area in your kitchen?
-
Yes
No
Do you plan to have:
Check all that apply
How many people do you need to seat?
-
1
2
3
4
5
6
7
8
9
10+
Are there multiple cooks in your household?
-
Yes
No
For the primary cooks, are they left or right-handed?
-
Left-handed
Right-handed
Ambidextrous
Are there special physical limitations or requirements for:
If yes, explain:
What type of kitchen related activities will you be conducting?
Check all that apply
Do you need special areas in or near your kitchen for:
Check all that apply
What other activities take place in the kitchen?
Do you want to display fine china, stemware, or collectibles in your kitchen?
-
Yes
No
Tell us what you don't like about your current kitchen
Please list any other items you feel we should know: (ie: move a wall, enlarge a window, special problems you might be concerned with, questions you may have, etc.)
Do we have your permission to contact you in order to set up a consultation appointment?
-
Yes
No
If yes, what is your preffered method for us to reach you?
-
Cell Phone
Home Phone
Office Phone
Email
