@ * Fields in RED are required to submit the form and to receive a copy of the consumer awareness report. *Name: Address: City:        State:       Zip: *Phone: Alt. Phone: *E-Mail: Best Time to Contact You:   Project Type?  Do you need design service?   Yes No N/A How long have you been thinking about the project?  Reason for undertaking the project?  Project budget range?  Have you dealt with a contractor before?  Yes No N/A If so, was it a good experience?  N/A Yes No How soon would you start?  Have you received any other quotes?  Yes No N/A If so, how may quotes have you received?  Were they within your budget?  N/A Yes No

Eichhorst & Company Phone:  815.675.6151