My Name Is	Title Dr. Mr. Mrs. Ms    First Name *     Last Name *
I have had previous renovation work done.	Yes  No
	If yes, by who?
I am aware of RENOCanada due to:
A RENOCanada Advertisement:	-- Select One -- Fabuloussavings.com Jazz FM CHFI CFRB Home Improvement Show Clasical 94 Jack FM Other Radio Station City TV A Channel Sun TV OMNI TV CP 24 Other TV - Not sure of channel Toronto Sun Tornto Star Scarborough Mirror 24 Newspaper Newspaper - not sure name Seen Truck Drove Past Store Walked into Store Seen Lawnsign Recieved Cupon of Flyer in Envelope <\SELECT>
Direct Referral from Someone:	Name Phone Address
Internet Search Engine	Google Yahoo MSN Other
About My Home and Plans:
My home is:	-- Select One -- Less than 1 Year Old Less than 5 Years Less than 10 years 10 – 20 Years Old 20+ Years Old *
I have owned it for:	-- Select One -- less than 1 year less than 5 years 5 – 10 years more than 10 years *
My home currently has: (please check more than one if applicable)	* Bathrooms: 1 Bathroom 2 Bathrooms 3 or more Bathrooms Powder Room * Kitchens: 1 Kitchen More than 1 Kitchen Mud Room * Laundry: Main floor Laundry Room Second floor Laundry Room Basement Laundry Room
I am planning to renovate: (please check more than one if applicable)	Main Bathroom Powder Room Ensuite Basement Bathroom Kitchen Laundry Room Full Basement Mud Room Other
I would like to start my project within the next:	-- Select One -- 3mo. 6mo. Not Certain *
I have the following for reference:
Clear Idea of what I want:	Yes   No *
Picture(s) from:	Magazine(s) Brochure(s) Other
Drawings:	Yes   No * (If yes, brief explanation)
Product Information:	Product and company
Estimates / quotes:	Yes   No *     If yes -- Select One -- For Work For Product Other
Budget	-- Select -- Less than $5000 $5001 to $7500 $7501 to $10000 $10001 to $12500 $12501 to $15000 $15001 to $17500 $17501 to $20000 Greater than $20000 *
My motivation to renovate is:
Additional information about my project:	Type a brief description of your project here
(check more than one if applicable)	Upgrade my house Improve my lifestyle Better reflect my tastes Improve functionality Get my house ready to sell Modify to accommodate physical disability
How to contact me:
The consultant can reach me at the following numbers:	Home: * (ie "4165551212" numbers only) Day/ Work: ext Cell:
I can also be reached by:	Fax: E-mail: *
My address is:	Street Number: *  Street Name: * Suite or Unit: City: -- Select -- Ajax Ashgrove Ballinafad Belfountain Bolton Brampton Brooklin Brougham Buttonville Caledon Caledon East Cheltenham Cherrywood Claremont Clarkson Elgin Mills Etobicoke Georgetown Glen Williams Gormley Green River Greenwood Halton Hills Hornby Huttonville Inglewood King City Kinsale Kleinburg Langstaff Lorne Park Maple Markham Milliken Milton Mississauga Mono Road Nobleton Norval Oak Ridges Oakville Pickering Pickering Village Port Credit Preston Lake Richmond Hill Ringwood Sandhill Scarborough Snelgrove Stewarttown Stouffville Streetsville Terra Cotta Thornhill Toronto Unionville Vaughan Victoria Whitby Whitevale Wilcox Lake Wildfield Woodbridge ----------------------- Other * Province: Alberta British Columbia Manitoba New Brunswick Newfoundland & Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory * Postal Code * (ie "A1A 1A1" space between )