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*First Name:
*Last Name:
*Address:
*City:
*State:
*Zip:
*Phone:
*Email:
*Purchased From:
Purchased Through:
*Date Purchased:
*Date Installed:
Serial Number:

Purpose:
New Construction
Remodel
Countertop Replacement

Application:
Kitchen
Countertop
Island
Tile/Flooring
Bathroom
Vanity
Tub Surround
Shower
Other
Bar Top
Fireplace Surround
Flooring 		Furniture Top
Table Top

Select One:

Male
Female

Select One:

Single
Married

Age:
25-34
35-49 		 
50-64
65+

OWN:
Home
Condo
Townhouse
Apartment 		RENT:
Home
Condo
Townhouse
Apartment

If You Own A Home, What Is The Age:
0-5 years
6-10 years
 11-20 years
21+ years

Household Income:
Under $35,000
$35,000 - $59,000
$60,000 - $99,000 		$100,000 - $249,000
$250,000 +

Value Of Home:
Less Than $100,000
$100,000 - $249,000
$250,000 - $499,000
$500,000 - $999,000
$1,000,000 +

How Did You Hear About Cambria? (check all that apply)
Friend/Family
Neighbor
Internet
Television
Radio
Print Ad/Magazine
Newspaper
Showroom
Parade of Homes
Home & Garden Show
Kitchen & Bath Retailer/Store Display
Builder
Architect
Interior Designer
Other:  

Why Did You Select Cambria?
(Please select your top 3 reasons, 1 being the most important.)
#1 Reason:

#2 Reason:

#3 Reason:

How was your Cambria purchase & installation experience?
1. It was easy obtaining a price quote for my Cambria.
Strongly Agree Agree Disagree Strongly Disagree
2. The benefits of Cambria were fully explained to me prior to my purchase decision.
Strongly Agree Agree Disagree Strongly Disagree
3. My questions were answered in a clear and understandable manner prior to my purchase decision.
Strongly Agree Agree Disagree Strongly Disagree
4. I was pleased with the available Cambria color selections.
Strongly Agree Agree Disagree Strongly Disagree
5. Overall, I was pleased with my purchasing experience.
Strongly Agree Agree Disagree Strongly Disagree
6. My Cambria product was delivered on schedule.
Strongly Agree Agree Disagree Strongly Disagree
7. My Cambria product was properly installed.
Strongly Agree Agree Disagree Strongly Disagree
8. Do you have a second residence for which you will consider Cambria?
Yes No
9. Would you recommend Cambria to friends or family?
Yes No
If yes, why?
10. Is there a family member or friend you would like us to contact now and introduce them to Cambria?
Yes No
  Name:
  Address:
  Phone:
Please tell us how we can serve you better?