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* - Required fields |
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| *First Name: |
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| *Last Name: |
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| Company Name: |
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| *Your Email Address: |
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| *Phone: |
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| Fax: |
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| Type of Construction: |
Existing Office Space |
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New Construction / Renovation |
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| Area(s) to be treated: |
(select all that apply) |
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Open Office w/Panels or Barriers 53" or Higher |
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Open Office with Low or No Barriers 53" or Lower |
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Enclosed Offices |
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Medical Offices / Exam Rooms / Counseling Offices |
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Nurse's Stations / Emergency Room / ICU |
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Other.... check box & please explain below:
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| Type of privacy required: |
(select all that apply) |
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Confidential Privacy (conference rooms, board rooms, closed offices) |
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HIPAA / GLBA Regulations |
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Reduced Distractions (open office workstations) |
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| Ceiling Height: |
8' - 8'6"
8'7" - 10'
12' - 16'
> 16' |
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Other.... please explain
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| Ceiling Type: |
Suspended
Sheetrock
Concrete |
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Wood
Metal |
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Other.... please explain
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| *What is your timeframe? |
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| Comments / Questions: |
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Although CAD drawings are preferred, we can work with most other file types such
as PDF, jpg, gif, tif, etc. If neither of the above is available, go ahead and submit this form
and fax a fairly proportional hand-sketched drawing with overall dimensions to (205) 449-2062. |
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You will receive an email confirmation once the information has been submitted.
There are five required (*) fields on this form.
If the form is submitted without filling in the required fields,
all information on this form will have to be re-entered. |
