Name*

Email Address*

Do you have small children? Do you have small children? Yes No

Do you have teenagers? Do you have teenagers? Yes No

Are there senior citizens living in the home? Are there senior citizens living in the home? Yes No

Do you and your family eat in the kitchen? Do you and your family eat in the kitchen? Yes No

Do you and/or your family study or do homework in the kitchen? Do you and/or your family study or do homework in the kitchen? Yes No

Do you need a desk/workspace in your new kitchen? Do you need a desk/workspace in your new kitchen? Yes No

Do you have guests over frequently? Do you have guests over frequently? Yes No

Do you want an entertainment/sound system in the kitchen? Do you want an entertainment/sound system in the kitchen? Yes No

Do you have any special needs that need to be taken into consideration? Do you have any special needs that need to be taken into consideration? Physical Handicap Kosher Other None

How many people typically cook at a time? Between 1-10 people

The primary cook is: The primary cook is: Right Handed Left Handed Ambidextrous

How tall is the primary cook?

The secondary cook is: The secondary cook is: Right Handed Left Handed Ambidextrous

How tall is the secondary cook? (Please enter a value between 1 and 10)

Do you cook large meals frequently? Do you cook large meals frequently? Yes No

Do you frequently prepare meals "on-the-run"? Do you frequently prepare meals "on-the-run"? Yes No

Do you need extra storage space in the kitchen? Do you need extra storage space in the kitchen? Yes No

Do you need an extra pantry? Do you need an extra pantry? Yes No

Will you be using existing appliances? Will you be using existing appliances? Yes No

If so, please list your appliances and their measurements:

Will you be buying new appliances? Will you be buying new appliances? Yes No

If so, please list brand and model numbers:

What type of stove top will you be using? What type of stove top will you be using? Gas Electric N/A

What type of oven will you be using? What type of oven will you be using? Gas Electric N/A

Do you plan to use an integrated stove? Do you plan to use an integrated stove? Yes No

Do you plan to use the following: Do you plan to use the following: Separate/Single Oven Double Oven Combo Microwave Oven

Would you like a ventilating device? Would you like a ventilating device? Downdraft Hood None

(select all that apply) (select all that apply)

Will you be using any special appliances and/or devices? Will you be using any special appliances and/or devices? Commercial-Style Stove Toaster Oven Warming Oven Microwave Oven Commercial-Style Refrigerator (Sub-Zero) Icemaker Dishwasher Trash Compactor Garbage Disposal Hot Water Dispenser Water Filtration System Other None

What do you like most about your current kitchen?

What you dislike about your kitchen?

Would you consider structural changes (windows, doors, walls, etc) to enhance your design? Would you consider structural changes (windows, doors, walls, etc) to enhance your design? Yes No

Do you need space for recycling? Do you need space for recycling? Yes No

Do you have a color scheme in mind? Do you have a color scheme in mind? Yes No

If so, please elaborate:

What is your preferred style? What is your preferred style? Colonial Contemporary Shaker Classical Eclectic No Preference Other

If other, please elaborate:

What material do your prefer for your countertops? What material do your prefer for your countertops? Laminate Solid Surface Granite Ceramic Tile No Preference Other

If other, please elaborate:

What material do your prefer for your sink(s)? What material do your prefer for your sink(s)? Surface Mount Undermount Double Bowl Single Bowl Corner Sink Country Sink Stainless Steel Porcelain Composite No Preference Other

If other, please elaborate: