First Name*

Last Name*

Street Address

City, State, Zip

Email Address*

Telephone

Best time to call

What would you like to receive more information about? Log Homes Log Furniture Log Accents All

Would you like to receive a furniture catalog? yes (fill in address above) no

When do you plan to begin construction? less than 1yr 1yr-2yrs 2yrs-3yrs over 3yrs

Do you already own land? yes no

Where do you plan to build?

What size home do you plan to build? less than 1000 sq/ft 1000-2000 sq/ft 2000-3000 sq/ft more than 3000 sq/ft undecided

What is your planned budget? (not including land) under 100K 100-200K 200-300K 300-350k over 350k unknown

Do you already have a floor plan? yes no

Would you like assistance with designing a floor plan? yes no

Any specific information you would like us to know? (such as, special conditions at your site, what type of style you are looking for, etc.)

Any specific questions you would like us to answer?

How did you learn about North Country Log Homes, Inc.?

Internet (what did you search for)

Magazine (name of magazine)

Newspaper (name of paper)

Home Show (which one)

Friend/Relative Yellow Pages TV