Name:                 

 

Address:             

 

City/ State/ Zip:  

 

Phone Number:    

 

Alternate Phone:  

 

Fax Number:        

 

Email Address:     

 

Preferred Contact Method:  Phone   Fax   Email

 

If phone, what is the best time?    AM   PM 

 

How did you hear about us?

Referral  CraigsList  Flyer   Other

 

 

 

 

 

 

 

Preferred Appointment Date: 

 

Preferred Appointment Time:  AM   PM 

 

 

 

 

 

 

 

 

 

Alternate Appointment Date: 

              

Alternate Appointment Time:  AM   PM 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


 Wood Blinds

 

 Faux Wood Blinds

 

 Shutters

 

 Vertical Blinds

 

 Other 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Window #11:  Width    Height

Window #12:  Width    Height

Window #13:  Width    Height

Window #14:  Width    Height

Window #15:  Width    Height

Window #16:  Width    Height

Window #17:  Width    Height

Window #18:  Width    Height

Window #19:  Width    Height

Window #10:  Width    Height

Window #11:  Width    Height

Window #12:  Width    Height

 

 

 

© 2007 Eclipse Window Coverings, LLC