First Name: Last Name:

Street Address: City:

State: Zip:

Email: Phone:

Which room(s) are you looking for? Please check all that apply:

Living RoomFamily RoomDining RoomKitchenGuest BathroomKid's BathroomMaster BathroomMaster BedroomKid's BedroomGuest BedroomHome OfficeMudroomOther

Why do you want to redo this space?

Please list all family members in the home and their ages, as well as any pets that you might have:

What new elements would you like to see in your space(s)? Please click all that apply:

Wall color or wallpaperChairs (dining, upholstered, lounge)Tables (end, side, coffee, dining)Storage pieces (media cabinets, bookshelves, bureaus, dressers, toy storage)Flooring (carpet, wood, tile, rugs)Window treatments (drapes, curtains, blinds, shutters, shades)Artwork and other accessoriesLightingSoft furnishings (fabrics, linens, drapery, pillows)Cabinets (kitchen and bath)Appliances (kitchenCountertops (kitchen and bath)Other

Place a check mark next to any of the following styles that you like:

Option 1

Option 2

Option 3

Option 4

Option 5

Option 6

Where do you usually shop for furnishings?

Designer showroomsAntique/vintage shopsOutdoor markets and craft fairsPottery Barn/Crate and Barrel/West ElmRestoration Hardware/Room and Board/Mitchell and Gold/ArhausEthan Allen/ThomasvilleDepartment home stores such as Macy’s or BloomingdalesOnline sites such as One Kings Lane, Wayfair, Ballard Designs, Serena and Lilly, AmazonOther

Where do you go for design inspiration?

Magazines like Dwell, Architectural Digest, House Beautiful, Elle DecorHouzzApartment TherapyPinterestHGTVThis Old HouseFriends and FamilyOther

What is your budget for this project?

If there is anything else you’d like us to know about your project? Please explain here: