VELUX America Brochure Order Form

Contact Information

Title: Ms. Mrs. Miss. Mr.
First Name:	Last Name:
Address Line 1:	Address Line 2:
City:	State:
ZIP Code:	Home Phone:
Business Phone:	e-mail:

Providing your email address enables VELUX to keep you informed of new developments by sending you information on product updates, special offers, and after sales service.

Customer Feedback
1. Would you like to receive product updates via e_mail?
YesNo

2. How did you hear about us?

Project Information
3. Are you building a new home or remodeling an existing home?
New ConstructionRemodeling

4. How soon will your project begin?
Less than three months
4-6 months
7-12 months
More than one year

5. Are you currently working with a builder or contractor?
Yes
No

6. If "Yes", May I have your builder or contractor's name?

If "No", let me help you find a VELUX preferred installer.

7. How many skylights are you planning to install in your home?
1-23-67-1011+

8. In what room(s) will you be installing skylights?
Bathroom
Bedroom
Bonus Room/Attic
Dining Room
Kitchen
Living Room
Porch/Patio/Sunroom
Other

By submitting this form, you will recieve the Velux Collections Home Plans Book and a product catalog. We respect your privacy, and will never sell your personal information to another company.