1.  New Screen (make new frame) Circle One :  Yes / No
	
	2.  New Screen Frame Color :  White, Gray, Bronze, Mill (Silver) 
	
	     Custom:  Explain_______________________________

	3.  Re-screen (use existing frame)  Circle One:  Yes / No 

	4.  Wickets:  $30.00 each Circle One,  Yes / No

	5.  Wicket Color:  White, Gray, Bronze

	6.  Is screen larger than 4 feet by 5 feet in size:  Yes / No
	     Note:  If Yes, you will have to speak w/your supervisor for pricing

7.  Is there a place for us to park and set up?  (need 8 x 12 ft space for table,         
     next to where we park) Note:  If there is no place for us to park and set   
     up, your installer will  have to bring screens to your office and we will
     have to build them in your shop.

8.  Number of Screens needed:___________________ *(Note:  Building on-      
site requires 3 or more screens.  All others will be built in the shop after the installation.  Some exceptions do apply.

	9.  If  less than (3) screens are screens going to be in Your Shop?  Yes/No

10.	If less than (3) screens are we to do work On-Site with a $45.00 trip                                      
       charge? Yes/No
	
11.	Day of Installation:__________Time of Installation:_____________

12.	Name and Telephone of Sales Rep.______________________________

	13.  Company/Office Location Rep works for_________________________	
           
           14.   Customers Information:  Name, Address and Phone number
	     ____________________________________________________________
	     ____________________________________________________________
	
           15.  Job, Purchase or Lead number______________________(circle one)