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| Date: _____________________ | ||||
| Name: __________________________________________ | ||||
| email: __________________________________________ | ||||
| Phone Numbers: Work: _____________ Home: _____________ | ||||
| Number of consultation hours required: __1 or __2 | ||||
| Area: _____________________ (choose from list of areas on the web site) | ||||
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| Consultation for (check all that apply: | ||||
| __ Residential
__ Kitchen __ Bathroom __ Living Room __ Dining Room __ Bedroom __ Media Room __ Home Office __ Child's Room __ ADA/Universal __ other |
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| __ Contract/Office __ Retail __ Hospitality __ Healthcare __ Lighting Design | ||||
| Style Preferences: | ||||
| __ Traditional __ Contemporary __ Eclectic (various) __ Period | ||||
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| For ASID use only | ||||
| Designer Assigned : _____________________ | ||||
| Date: _____________________ | ||||
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