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Name:
   First Name:    Surname:
House name/number:
Street name:
Town/Village:
City:
Post code:
Contact tel number:
Room Details
My room measurements are :- (in mm)
Wall 1:
Wall 2:
Wall 3:
Wall 4:
Doors (tick as applicable):
There is a doorway on Wall 1, it measures (mm)
There is a doorway on Wall 2, it measures (mm)
There is a doorway on Wall 3, it measures (mm)
There is a doorway on Wall 4, it measures (mm)
Windows (tick as applicable):
There is a window on Wall 1, it measures (mm)
There is a window on Wall 2, it measures (mm)
There is a window on Wall 3, it measures (mm)
There is a window on Wall 4, it measures (mm)
The gas supply is on:
The water supply is on:
Special features required :
(tick all that apply)
glass wall units
extra high wall units
breakfast bar area
wine racks
plate racks
I have:
children
pets
mobility problems
special needs requirements
I am interested in a new:
kitchen bathroom bedroom home office
I like:
modern traditional style

(please specifiy more details below):
I would like it fitting by Inspirational Interiors:
Yes No
I would like the work fitting in approx:
I have a budget of approx:


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