Your Name :

Your E-mail Address :

Your Current Address :

City : State : Zip :

Address Of Jobsite :

City : State : Zip :

Home Telephone:
Work :
Cell :
Pager :
Fax :

Contractor / Builder:
Phone:

Are you going to have high-speed Internet access(Cable Modem, DSL, Etc.)?
Yes No

Is cable TV available in your area?
Yes No                                                        

Are you  going to have custom cabinetry or preformed cabinets?
Yes No

Are you  interested in Computer Networking in your new home?
Yes No

Are you  interested in a Telephone/Intercom System?
Yes No

Are you  interested in a Surround Sound System?
Yes No

Are you interested in Futureproofing your new home?
Yes No

Are you  interested in Whole House Audio Speakers?
Yes No

Are you  interested in Small Digital Satellite Systems?
Yes No

Are you  interested in a Security System?
Yes No

Are you interested in a Security Camera System to be displayed on any TV in the house?
Yes No

Are you interested in Lighting Control Systems?
Yes No

Are you interested in Home Automation Systems?
Yes No

Are you building a room in the house that is a dedicated theater?
Yes No

Do you find it hard to operate your system you have now?
Yes No

If you are interested in a structured prewire plan for a house under construction, please answer this section:

What stage is the house in presently?

What is the size of your house in (heated) square footage?

What is the estimated date of closing?

How many people will live in the house?

Adults:
Children:

How many telephone numbers will you have?

Please list any equipment that you would like us to try to integrate into your system:

How did you hear about us?

Would You Like to be on our mailing list ? :
(Your information will be private and not used for any other purposes)

Please describe any other products or services that you are interested in or any additional questions or comments you may have: