Customer data form- Please print clearly

Name: ___________________________________	Today’s Date: ________________
Street Address: ___________________________________	Phone Number ____________________________
City State ____________	Zip _____________
Service Requested [ ] BACIC -2 payments $440/150 –Total $550 [ ] TOP $550 upfront [ ] Rush $640 up front	Extra Services Requested [ ] New Roof color/style consulting $70 [ ]Porch Design consulting $85 [ ]Garage/outbuilding consulting $40
Shipping Options [ ]Free via Postal Service [ ] Priority Mail $15 [ ] UPS -2^nd Day Air $35	Email address [please print very clearly] ______________________________
TOTAL Payment $_________________ Please include fees for “Extra Services” with initial payment.

Building faces what direction? _______________

Relationship to other buildings [by itself, on a block, other useful neighborhood information]

Age [when built, if known] __________________Architectural Style [optional]_________________

Windows: material, wood, vinyl ,metal. Do you plan to paint them?

Special architectural feature of note:

Color of roof - any changes planned for it? _________________________________________________

Brick, block or stone colors of note:

Your color preferences: list, if you desire, your general thoughts on what you might like to see. [e.g. light body, medium trim or we/I like greens, etc.]

Color Schemes: are you interested in only historic colors, modern colors? Would like a highly detailed schemes or something subtile? On a scale of 1 to 10, how much detail do you with to highlight? What words would you like your new color scheme to elicit?

When are you planning on painting?

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