CUSTOMER INFORMATION FORM

Name
Address
City, State, Zip
Phone (H)
Phone (W)
Email Address

1.	I am considering the following room addition:	Add Family Room
		Add Bathrooms
		Add 2nd Story
		Add Bonus Room
		Room Extension
		Master Bed & Bath

2.	I would like to add the following square footage:	200-500 Sq. Ft.
		500-1,000 Sq. Ft.
		1,000+ Sq. F.

3.	What is the time frame for beginning your project:	1 Month
		6 Months
		1 Year

4.	Do you have preliminary drawings or architectural plans:	Yes
		No

5.	Will you be obtaining financing for this project:	Yes
		No

Beach Cities Construction Lic. #B580586 18226 McDurmott St., Suite D Irvine, CA 92614 Email: bchciti@aol.com 949-722-1791 Office 949-722-1702 Fax