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* All Fields are Required
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first name:
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last name:
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Your email address:
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Your phone number:
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address:
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city:
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state:
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zip code:
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Please check off all of your pending home improvement projects:
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Home Decorating (interior decorator; drapes & blinds; closet organizers)
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Home Improvement (fences; painting; lighting; security system; pool)
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Home Furnishings (new furniture; rugs; wide-screen TV; home theatre)
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Lawn & Garden (gardener; tree removal; snow removal; patio furniture)
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Professional Services (dentist; doctor; pediatrician; financial planner)
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Personal Services (therapeutic massage; pet sitting/walking; hair salon)
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Sports & Recreation (fitness club; golf courses; tennis club; country club)
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Children's Services (preschool; daycare; educational programs; music lessons)
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Other (new/used car; vacation planning; boats; apparel; toys; books)
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Please specify your specific areas of interest (blinds & drapes, fence, shed, pool,
landscaper, insurance, attorney, etc.):
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When do you plan on starting the project(s)? 2 weeks, 1 month, 6 months, etc?
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I would like a $50 Gift Certificate from this advertiser:
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1st Choice:
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2nd Choice:
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3rd Choice:
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additional comments or feedback:
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