1. Number and approximate ages of family members: 

              __ infants         __ young children    __ teens

              __ 20 to 60 yrs    __ 61 to 70 yrs      __ 70+  

        2. Where will your family eat after you remodel/build? 

             __ Kitchen    __ Dining Room  __ Center island  __ Other:________________

        3. What other activities will take place in your new kitchen?

             __ Laundry         __ Homework    __ Watching TV

             __ Paying Bills    __ Computer Center	__ Other:__________

        4. Will there be more than one cook working in the kitchen at the same time? __ Yes   __ No         

        1. What are your color preferences for your new kitchen? ________________________

        2. Have you created a scrapbook of notes, photos, and ideas that you would like to use

              in your new kitchen?   __ Yes   __ No 

        3. What do you like about your current kitchen? _________________________________

        4. What do you dislike about your current kitchen? _______________________________

        5. Do you require a recycling center in your kitchen?  __ Yes  __ No

        6. Will you be keeping your existing appliances? 

              Dishwasher:      __ existing    __ new

              Refrigerator:    __ existing    __ new

              Oven/Range:      __ existing    __ new 

        7. What is your style preference for your new kitchen? 

              __ contemporary    __ formal   __ country   __ traditional

        1. When would you like to begin your project? _________

        2. When would you like your project completed? ________

        3. If you are building, is the kitchen in your contract? __ Yes  __ No

        4. Do you have a budget for this project? __ Yes $________     __ No

        1. Name: _______________________________________________ 

        2. Address: ____________________________________________

        3. City: _______________________ State: ___ Zip: _______

        4. Home Phone: ___________________________ 

        5. Work Phone: ___________________________ 

        6. Fax: __________________________________ 

        7. New Home Address: ___________________________________ 

        8. City: _______________________ State: ___ Zip: _______

        9. Builder Name (if applicable): _______________________

        10. Phone: _______________________________ 

        11. Architect Name (if applicable): ____________________

        12. Phone: _______________________________