Customer Intake Form
Prime Countertops
Type of Lead
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Walk In
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How did you hear about us
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Google
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Family or Friend
Sign / Truck / Employees
Builder / Contractor / Designer
Magazine
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Type of Project
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Kitchen
Bathroom
Laundry
Outdoor Area
Remnant
New Construction
Other
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Full Name
*
Email
Phone
Address
Project Notes
Dimensions
Material Selections
Edge Selections
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