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Homeowner
Contractor
Business
Other

Name:               
Address:            
City:                   
State:                  VA MD
ZIP/Postal Code:
Telephone 1:       
Telephone 2:       
Rental Property address if work is being done there:

Email Address:      

Best way to get a hold of me is:
Telephone 1
Telephone 2
1 2 3 4 5 6 7 8 9 10 11 12 :00 :30 AM PM
E- mail

I am interested in: (check all that apply)

Windows:

Bay/Bow Window
Casements
Double Hung
Garden Windows
Special Shape
Picture Windows
Sliding Windows
Other, Please Describe:

Colors: Exterior
Windows

White Exterior
Chocolate Exterior
Green Exterior
Red Exterior
Tan Exterior

Doors:

Patio Sliding Doors
Inswing, Outswing
Sliding Doors
Storm Doors
Other, Please Describe:

How many years have you owned this property? 1-5 5-10 10-15 15-20 20-25 25-30 30 Plus

What type of windows do you have currently?   Wood Windows Steel Windows Aluminum windows

Approximately how many windows:
Approximately how many doors:     

Your biggest window problems are?

Hard to clean
Unable to open or close
Won't stay open
Need painting & caulking
Glass has 'clouded up' inside
Condensation on the window
Too drafty and cold
Bugs get in the house
Too much noise from outside
Does not insulate well enough

I am looking to get started:

Right Now
Within the next Month
0-3 Months
3-6 Months
6-12 Months
Over 12 Months

How did you learn about our web site?

Phone Books:

Red Book Verizon Yellow Book

Mall Display
Special event
Newspaper
Received Ad in Mail
Door Hanger
Referral

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Additional Notes:

Better Windows By Beth Phone: (703) 327-1200 Fax: (703)327-1210 E-mail:beth@betterwindowsbybeth.com Managed by