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First Name	Last Name
Company Name
Street Address
City	State	ZIP Code
Telephone (Daytime)	Telephone (Evening)
Best time to call	Email Address
Where did you hear about us? Newspaper Radio Flier Google Ad Yahoo Ad MSN Ad Search Engine
How many windows are you replacing/purchasing?
What sizes of windows/shapes are you interested in? Please indicate width and height of each window. Also shapes: single hung, double hung, picture windows, awning, casement, bay, slider, etc.
Why do you wish to purchase new windows? (check all that apply) Heat Convenience/operation Cleaning Appearance
When will you be purchasing new windows? Within 30 days 1 to 3 months 3 to 6 months 6 months or later
How will you finance the windows? Funds on hand Home equity loan Bank loan Other		Do you own the property? Yes No
We offer installation in Oregon. Would you like a quote for installation? Yes No
Comments, questions or other information to help us give you a complete quote.