Please fill out the following form to submit your comments/questions. Please hit the submit button only once to avoid duplicate submissions.

* denotes required fields
* Name:   Company: * Address Line 1:   Address Line 2: * City: * State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming * Zip: * Telephone (Please provide all applicable numbers and select preferred):    Home:      Work:      Cell:   * E-mail:
*	1.	How did you learn of the program?
		Newspaper Article Magazine Article Friend Other
	2.	Are there any children in the home?
		Yes No
	3.	Are there any pets in the home?
		Yes No
	4.	What is your profession?
	5.	Have you worked with an interior designer before?
		Yes No
*	6.	Our “Spruce Up” program allows for a minimum of one hour and a maximum of two hours for each design consultation. Please select below. Design Hours requested:
		1 Hour (Minimum) 2 Hours (Maximum) Undecided
*	7.	Please describe your design style: check all that apply.
		Traditional Contemporary Transitional (a blend of traditional and contemporary) Period Design Ethnic Theme Room/Novelty Formal Casual Eclectic Pottery Barn / Crate and Barrel style Additional Information:
*	8.	First design choice/ area to be focused upon. Please select one.
		Foyer Stairway Kitchen Powder Room Master Bathroom Family Room Living Room Dining Room Children’s Bedroom Master Bedroom Guest Bedroom Home Office Home Theater Basement/Recreation Room Storage solutions Additional Information:
*	9.	Please select from the following list: check all that apply.
		Space Planning Suggestions for rearranging existing furniture Accessorizing advice Ideas for new furniture purchases Paint color help Window treatment advice Lighting recommendations
*	10.	Second design choice/ area to be focused upon. Please select one.
		Foyer Stairway Kitchen Powder Room Master Bathroom Family Room Living Room Dining Room Children’s Bedroom Master Bedroom Guest Bedroom Home Office Home Theater Basement/Recreation Room Storage solutions Additional Information:
*	11.	Please select from the following list: check all that apply.
		Space planning Suggestions for rearranging existing furniture Accessorizing advice Ideas for new furniture purchases Paint color help Window treatment advice Lighting recommendations
*	12.	The Owner agrees to release and hold the ASID Washington Metro Chapter and the Consulting Designer harmless from any and all claims arising out of the services provided to the Owner under this program.
		Please check box