Blind Imaging Survey




        First name:                                  MI:        Last name:






        City:                                              State:                             Zip:


        Phone:                                               Fax:





        Would you like to talk to a contract service representative?

        yes    no


        When is the best time to call?

        6:00 am-9:00am  9:00am-12:00pm  12:00pm-3:00pm


        What application of Blind Imaging are you interested in?

        Residential (use of Blind Imaging in your home)

        Commercial (Blind Imaging used as an advertising tool)

        Blind Signs  (Blind Imaging used as a sign for your business)


        Please describe the area you are interested in putting these blinds in?


        example: bedroom, living room, office front, store windows, etc..



        Do you have a theme in mind for your room or blinds?

        yes    no


        If Yes, please give a brief explanation.



        Is there a color pattern you would like us to work with?

        yes    no


        If Yes, please give a brief explanation.



        Does your company have a  logo you would like to use?

        yes    no