FIRST NAME* LAST NAME* EMAIL ADDRESS* PHONE NUMBER* ADDRESS 1 ADDRESS 2 CITY* STATE* ZIP/POSTAL CODE* WHEN DO YOU PLAN ON MAKING YOUR PURCHASE? Within One MonthOne to Three MonthsThree to Six MonthsOver Six Months WHAT TYPE OF FLOORING ARE YOU INTERESTED IN? CarpetLaminateVinylTileHardwoodArea Rugs HAVE YOU BEEN IN THE STORE IN THE LAST 30 DAYS? YesNo