Business Name
Contact Name
Website
Email(required)
Address 1
 Telephone
Address 2
 FAX
City
State
Zip
Country
Do you own, rent or lease the space or building?
Is the lease or rental agreement signed?
Is the building existing or new construction?
Proposed finish date/grand opening?
Free Dispensary only layout or Full Design Services?
Dispensary Only Layout
Full Design

If free, will Reception and Waiting layouts be needed?

Budget for interior improvements (carpet, paint, etc.):

Budget for fixtures/furniture for Dispensary and/ or Waiting areas:
Your primary concern is (please rank between 1 and 4 with 1 being the most concerning):
Cost:  Timing:  Aesthetics:  Other: 
Building Type:
Professional Medical Interior Mall Strip Mall
Freestanding
What floor is the space located on?
What do windows look out over?

More emphasis on retail or professional services?
Retail Services
Professional Services

Current office Aesthetics:
Traditional Contemporary Modern Other
Desired office Aesthetics:
Traditional Contemporary Modern Other
Color scheme existing or to be determined?
Existing To be determined
Desired color scheme?
Freestanding cabinetry or "built-in" style?
Will you keep any existing furniture/fixtures/carpeting/etc.?
Yes No

If yes, what?

Total number of frames to be displayed:
Women's Men's Sunglasses
Any locking displays? Yes No
If yes, frame style?
  Quantity?
Total number of dispensing tables:
Computer compatible dispensing tables?
  Flatscreen?
Number of:
Opticians: Receptionists: Doctors:
Other
Total number of waiting chairs:
Are you working with:
an Interior Designer
Architect
Other design/display company
  If yes, may we contact them?
Yes No
  Name: 
  Phone:
If you have not done so, please fax, mail or e-mail us a floor plan including accurate dimensions, ceiling height, window & door placement, any elecrical outlets and heating vents, etc. Photos are also very helpful before beginning and required before installation. Please feel free to call us with any questions you may have. Our Design Group can be reached at 800-833-6626. We look forward to hearing from you soon.

Comments: