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EXIT Cook's Woodstock 1915 Needham Avenue Nemaha, IA 50567 Shop Phone: (712) 636-4567 Fax Number: (723) 636-4475 Please print this form, fill it out and return it to us or bring it with you to your interview. - - - - - - - - - - FAMILY AND LIFESTYLE INFORMATION - - - - - - - - - - |
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(*) Required Answers
*First Name:___________________________ *Last Name:________________________ *Street Address: ______________________________ Address (cont.): ______________________________ *City: ______________________________ *State: _______ *Zip: ______________ Home Phone: _______________________ Work Phone: ______________________ *E-mail: ______________________________ Preferred Method of Contact (check one): ___Home Phone ___ Work Phone ___ Email Will you be remodeling or building a new home? ___Remodel Existing Kitchen ____New Construction How long do you plan on living in the home you are remodeling/building? ___ Less than 10 years ___ More than 10 years ___ I don't knowHow many family members? ____ What room will your family sit down to eat in after you remodel/build? ___ Kitchen ___ Dining Room ___ OtherWhat other activities will take place in your new kitchen (Check all that apply)? ___Watching TV ___Computer Work ___HomeworkHow often do you purchase groceries (Check all that apply)? ___For each meal ___Purchase non-perishable items in bulk - - - - - - - - - - COOKING STYLE INFORMATION - - - - - - - - - -Is the primary cook: ___Left Handed ___Right Handed What is the primary cook's cooking style (check all that apply)? ___Bringing meals home ___Quick and simple meals ___Family mealsWhat does the primary cook prefer (check all that apply)? ___No one else in the kitchen while preparing meals Is there a secondary cook? ___Yes ___No
- - - - - - - - - - KITCHEN DESIGN INFORMATION - - - - - - - - - -Have you created a scrapbook of notes, photos, and ideasthat you would like to use in your new kitchen? ___Yes ___No What do you like about your current kitchen? ___________________________________ ______________________________________________________________________ ______________________________________________________________________ What do you dislike about your current kitchen? ________________________________ ______________________________________________________________________ ______________________________________________________________________ What appliances do you plan on using in your new kitchen (check all that apply)?
- - - - - - - - CABINETRY AND COUNTERTOP INFORMATION- - - - - - - -___Alder ___Cherry ___Maple ___Oak ___Pine ___Don't know What type of finish would you prefer? ___Natural ___Stained ___Stained with GlazeWhat type of Door style do you prefer? ___Flat (Contemporary) ___Raised Panel ___Recessed Panel ___Don't knowDo you prefer arched panels on the wall cabinet doors? ___Yes ___No What options would you like to use in your new kitchen (check all that apply)?
When would you like your project completed? _______________________________
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