City Zip Code

Phone (no spaces or dashes) Name of Neighborhood

Number of Years Living There Email Address

Last Time You Landscaped Your Property

Please Select One 1 year 2-3 years 3-5 years 5-10 years

Have you had any previous experiences with any landscaping companies?

Please Select One Yes No

If you answered yes to the question above, what companies?

Have you received other quotes, but the contractor has failed to show up?

Please Select One Yes No

What type of work are you looking for?

Are you aware you can shop our plant catalog online at BCN?

Please Select One Yes No

Now that you have looked at the plant catalog, are there any plants or trees you would like to see in your landscaping project?

What type of landscaping theme are you looking for?

Have you visited our website and seen something you would like to have?

Please Select One Yes No

If you answered yes to the question above, please tell us what you have seen.

How did you hear about Dr. Dan's

Please Select One Friend/Word of Mouth Welcome Wagon Gift Booklet Sign In Yard Or On Our Truck Community Phone Book Cool Savings/Dealspotter Ad RSVP Coupon Cards Online/Internet Search BBB/TBA Recommendation Best Of Hilltop Coupon Book Best Of Princess Anne Coupon Book Best Of Kempsville Coupon Book Town Planner Calender Trade Show Exibit/Booth

Do you have a list of work you would like to have done for your consultant?

Please Select One Yes No

Will you be ready to make a buying decision if you like what you hear from your consultant?

Please Select One Yes No

Have you priced out landscaping lately to know what a fair valued price is?

Please Select One Yes No

Will you be ready to make a deposit to have your work put on the schedule?

Please Select One Yes No

How soon do you need your project completed?

Please Select One Right Away Within 7-10 Days Within 10-21 Days Within 30-45 Days Just Shopping Around

Are you aware there may be a 2-3 week waiting list prior to your work coming up?

Please Select One Yes No

Are you aware you can click on the promotions page and use/print new and expired coupons?

Please Select One Yes No

Are you aware that Dr. Dan's accepts credit cards through Paypal?

Please Select One Yes No

What is your budget range for your landscaping project?

Please Select One $499-$2,499 $2,500-$4,999 $5,000-$7,499 $7,500-$9,999 $10,000-$12,499 $12,500-$14,999 $15,000 or more

Would you like to receive free gardening tips and periodic coupons?

Please Select One Yes No

Would you like to be added to Dr. Dan's preferred customer mailing list?

Please Select One Yes No

Can you be available Monday-Friday between 7:30am-4:30pm for your consultation?

Please Select One Yes No

Are you aware landscaping your home has a 100%-300% return on your investment dollars?

Please Select One Yes No