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| 1. How did you hear about us? |
Web search Referral Print Ad Other |
| 2. Have you seen us advertised on |
TV Radio Newspapers Magazines Direct Mail |
| 3. What kind of flooring are you interested in? |
Carpet Hardwood floor Ceramic Tile Area rugs Laminate
Sheet vinyl Other |
| 4. What is your purchase time frame? |
Immediate Less than 3 months 3-6 months Over 6 months |
5. Contact information
Please note: It is the policy of Village Carpet Flooring Cener never to share and distribute information entered into this form. If you choose, a salesperson will contact you to discuss your flooring needs. |
| Please have a salesperson contact me. Yes No |
| Name: |
| Phone: |
| Email: |
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| Code: |
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