Couth & Co Questionnaire

Personal Information
Full Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / County

Postal / Zip Code
E-mail *
How did you hear about us?
Property Information
Year Built
Property Type *

Flat/Apartment Detached house Semi-detached house Terrace house
How many people live in your home? *
Do you have pets, if so how many *
What would you like to achieve *

I just need new curtains and/or blinds I need to fall in love with my space again Out with the old, In with the new! New Bathroom New Kitchen I need a new extension
Total Space in square meter (if applicable)
Please upload floor plans in STEP TWO
Distance from ceiling to Floor
Date to Commence *

Month Day Year
I like your style!

What is your preferred look? To help us to provide you with inspiration please select from list below.
Preferred Style *

Traditional : Victorian, Edwardian or Georgian Vintage : Mid-Century modern Rustic Scandinavian Eclectic Romantic Bright and Bold Modern/Minimalist
Likes and Dislikes

I love patterns, bring it on! Not sure about patterns but happy to try No to patterns, just solid colours please
Are there any ceiling lights or do you need to light spaces with lamps?

Yes but I need new lights Yes but I want to change to spot lights No, I need to light spaces with lamps
Do you need pieces with storage?

Yes No Maybe
Would you like or need window treatments?

Yes No
Which, if any, pieces of furniture would you like to keep? Please provide measurements
Please upload photos of all pieces in STEP TWO
Please provide any additional information or comments
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Personal Information

Property Information

I like your style!