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About Your Business:

Business Name:
Business Type:	(Please select one) Corporate Government Educational Non-Profit Other
Business Size:	(number of employees)
Address:
City:
State:	Zipcode:

About Yourself:

Your Name:
Your Email Address:
Address:
City:
State:	Zipcode:
Age:	(Please select one) Under 25 26-29 30-39 40-49 50-60 Over 60
Gender:	Female Male
Education:	(Please select one) High School Some college Bachelor's Degree Master's Degree Doctorate Degree
Children in Household:	(Please select one) 0 1-2 3-4 5 or more
Occupation:	(Please select one) Accounting/Finance Executive/Senior Management Professional Management Technical/Engineering Administrative/Secretarial Sales/Marketing/Advertising Customer Service Support College/University Faculty Writer/Journalist Homemaker Other
Income:	(Please select one) Under 30,000 31,000-50,000 51,000-80,000 81,000-100,000 Over 100,000

About Your Interest:

Have you worked with an interior designer before?	yes no
What designer have you worked with in the past?
Have you worked with an architect before?	yes no
Are you considering an interior design project?	(Please select one) Not currently In the next 3 months In the next 3 to 6 months In the next 6 to 12 months Some time in future