Services Form

Contact Information:
Name:

First Name Last Name
E-mail:
Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number:

Area Code Phone Number
Birthday:
How did you hear about us today?
Household Information:
Children In The Home:

None 0-4y/o 5-12y/o 13y/o+
Pets in the home:

Yes No
Lifestyle:
Entertaining lifestyle:

Casual Formal
Hobbies and Activities:
Colors you're most attracted to:

Neutrals Cool Tones (Blues//Greens) Warm Tones (Reds/Oranges)
Colors you don't care for:
Which of these best describes your style:

Modern Farmhouse VIntage Farmhouse Modern Traditional Transitional Contemporary Urban Rustic Eclectic
Project Information:
Person(s) responsible for project decisions:
Project is to be done:

All at once In stages Within the next 3 months Within the next 6 months to 1 year
Please check all of the rooms to be included in the project:

Whole House Family Room Kitchen Dining Room Entry/Foyer Bedrooms Bathrooms Office/Study Basement
What kind of enhancements are you considering? (please check all that apply)

Furniture Window Treatments Accessories Lighting Flooring Paint/Finish Selections Kitchen Remodel Bathroom Remodel Basement Remodel Whole House Remodel
How involved do you wish to be in this project?

Very involved. I just need some initial guidance and will finish the project on my own. Involved. I'd like to work as a team with Black Dog Design House to complete my project. Minimally involved. We will mutually agree on an overall design and budget for this project, but Black Dog Design House is free to do their thing!
What is your budget for this project (including furniture, accessories, flooring, window treatments, etc)?

Less than $5,000 $5,000-$10,000 over $10,000
Please give a brief description of the project:
Décor Style
Houzz account:
Pinterest account:
Instagram account:
Where do you like to shop for furnishings & accessories?
Please arrange these design attributes in order of importance, 1 being the most important:
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Contact Information:

Household Information:

Lifestyle:

Project Information:

Décor Style