Name:         Email:    
			
		Phone:        Street:             
		
		City:         State:    
		
		Zip:                
		
		
		What Type of Blinds Do You Have?
		
		 Mini                Honeycomb/Pleaded Shades
		 Silhouette          Faux Wood
		 Wood                Verticles
		 Other
		
		
		How Many Blinds Do You Have?
		
		 1       6   
		 2       7    
		 3       8    
		 4       9   
		 5       10
		 11-15   16-20 
		 21-30   30 or More    
		
		What day do you prefer?
		
		 Monday   
		 Tuesday 
		 Wednesday  
		 Thursday  
		 Friday  
		 Saturday 
		 
		*Sundays are reserved for religious observation and time with family.
		
		
		What time slot do you prefer?
		
		 9:00am-11:00am
		 11:00am-1:00pm
		 1:00pm-3:00pm
		 3:00pm-5:00pm
		
		
		
		 Special Directions, Comments or Questions: