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		Client Name *		Street Address

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		Work #		Home #		Cell #

		E-mail Address *

		Range of Services and Products required: Space Planning    Color Consultation    Visual Merchandising    General Advice    Wood Furniture    Upholstery    Lighting    Wall Decor    Accessories    Custom Window Treatments    Custom Pillows/Bedding    Floor Coverings		Room(s) in which you would like design assistance: Living Room    Dining Room    Breakfast Nook    Family Room    Office    Den    Master Bedroom    2nd Bedroom    3rd Bedroom    Other

		How many people are living in the home?

		Are there any allergies to textiles?

		Are there any family members with special needs?

		Are there any pets?

		How do you entertain - intimate gatherings or large parties?

		Hobbies/Recreational Outlets:

		Please list any elements you would like to keep in the space(s):

		Color Preferences:

		Fabric Preferences:

		Describe Desired Attitude of Space:

		When would you like the project completed?

* Budget:

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