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(Estimate)?
		
		 10       60   
		 20       70    
		 30       80    
		 40       90   
		 50       100 or More
		
		
		Please Check The Following Boxes If It Applies To Your Blinds?
		
		 Blinds Have Headrails   
		 Blinds Are Behind Desks 
		 Blinds Will Require A Ladder To Remove  
		 Blinds Must Be Cleaned During Non Business Hours  
		 Building Has Limited Security Access(Security) 
		
		
		
		 Comments or Questions: