Your Name:
Home Phone:
Work Phone:
Best time to call:	am pm
Address:
City, State Zip:	,
E-Mail:
Are you currently living in the house where the pool or spa is to be built? Yes No
Is this new construction? Yes No
How soon were you planning on building? (Time frame for building) Immediate 3 months 6 months One year or longer
What is your budget? 15,000 - 20,000 20,000 - 30,000 30,000 Plus
Home Builder:
How did you learn about Lapaz Pools & Spas? Search Engine Yellow Pages Home Show Other
Comments: