Please enable JavaScript in your browser to complete this form.Thorough planning is an essential element in any successful remodeling project. Your bathroom may be a simple powder room or a spa like space. Complete a worksheet for each bath you wish to remodel or create. Check all items that are must haves and those you want to consider or add in the future. Be sure to ask everyone who will use the room for their input. We will help you to determine which items will fit within your budget and guide you on where to make your selections.Name *FirstLastEmail *Phone *What is your primary motivation for remodeling or adding a bathroom?What are your likes and dislikes of your current bath? What year was your home built?Has your bath been remodeled in the past?YesNoIf yes, what year?What floor of your home is or will your bath be locatedFirst FloorSecond FloorBasementOtherIf other, please explain:Please describe any known leaks, structural problems or barriers: This bathroom will be a: Master or other suiteMain bathroomGuest bathroomPowder roomChildren’s bathroomAre the primary users: AdultsChildrenGuestsAdults & childrenHow many primary users at one time?Will your bath be located in: An existing spaceAn existing space plus added space from adjacent room or an additionAn additionOtherIf other, please explain: If you are remodeling an existing bath, will you relocate or eliminate:Window(s) Door(s)VanityFixturesWallsOtherIf other, please explain: Will you use an Interior Designer for product and color selections?NoYes – Plekkenpol to select Interior DesignerYes – I am working with an Interior Designer. Please provide your Interior Designer’s name and contact information: Do you have ideas to share?Sketches, drawings, magazine cutouts, photos OtherIf other, please explain: Please list any pre-selected materials, fixtures, cabinets or other features: Will the entry door be:SwingingPocketFrenchBi-foldLockableNo lockOtherIf other, please explain: Will you incorporate any universal design or aging in place features? Wider doorway(s) and adequate space for wheelchair/walker accessTrolleyHanging sinkKnee opening under vanity or sinkNon-standard vanity height Accessible tubCurbless shower Grab bars, transfer posts or handrailsReachable faucet, faucet handles or foot controlsAdjustable shower head Hand held showerheadTemperature and/or pressure controlled faucets Levers instead of door knobsOther accessibility requirements or details: If other, please explain: Electrical Devices:Dimmer switch(s)Separate exhaust fan switchExhaust fan timerOtherIf other, please explain: # concealed outlets # standard outletsWill the bath include:TelevisionAudio systemSpeakersOtherIf other, please explain: Storage will be needed for:TowelsLinensToiletriesMedicinePaper productsCleaning productsTrash canJewelryHamperBooks or magazinesOtherIf other, please explain: Will the bathroom include: Small clothing closetWalk in closet with: Standard shelves, hooks and polesCustom closet systemOtherIf other, please explain: Vanity Features:Standard heightSingle vanity with one sink Double vanity and two sinksTwo separate single vanities with sinks Built-in vanity cabinet(s) Free standing furniture style cabinetRollout shelves DrawersDoorsOpen shelvingSeating at vanityOtherIf other, please explain: Sink(s):PedestalVesselUnder mountIntegral sinkDrop inSingle lever faucet Separate hot & cold handles Soap dispenser(s)OtherIf other, please explain: Mirrors:On recessed medicine cabinet Decorative above vanityThree-sided above vanityLighted shaving/makeup DoorWallOtherIf other, please explain: Toilet:Reuse existingRound bowl ElongatedStandard tankLow profile tankStandard heightElevatedPower assisted flushBidetAdjacent half wall Enclosed with doorOtherIf other, please explain: Shower features:No showerCombined with tub Separate shower enclosure Framed glass enclosure Frameless glass enclosurePre-made enclosure No door Sliding doorSwinging door Steam showerRecessed shelvesSeat/footrestShower curtain rodOtherIf other, please explain: Shower glass: ObscureClearDecorativeOtherIf other, please explain: Showerhead:Multiple showerheadsRain showerheadMassage showerhead Adjustable sprayerHand held showerhead Adjustable height showerheadBody spraysOtherIf other, please explain: Tub:Reuse existingNo tubOne personTwo personFree standing/ claw footDrop inUnder mountWith showerheadSoaking tubJetted – whirlpool/air bathStandard sizeLarger than standardSmaller than standard Shower doorShower curtainSteps for accessOtherIf other, please explain: Counter tops:LaminateGraniteCultured marbleCeramic tileManufactured quartzConcreteOtherIf other, please explain: Flooring:Glass tileCeramic tileNatural stoneVinylWoodCorkConcreteIn floor heat CarpetOtherIf other, please explain: Walls and ceiling:Glass tile Ceramic tileNatural stoneWallpaperWainscotChair railSoffitsCrown mouldRaised or vaulted ceilingOtherIf other, please explain: Artificial lighting:OverheadTrackPendantRecessedSoffitCeiling fan with lightExhaust fan with lightFan / light / heat combo Under cabinet Toe kickSensor lightingNight lightSpot on artShaving/makeup mirror(s)OtherIf other, please explain:Natural light:SkylightSolotubeWindow(s) Glass blockOtherIf other, please explain: Hardware:Towel and robe hooksTowel barsTowel ringsSoap/shampoo shelvesKnobs or pullsNo knobs or pullsOtherIf other, please explain: Windows:No new windowsNew windowsOtherIf other, please explain: Other inclusions:SaunaTowel warmerNew water heaterLaundry chute Toe kick step stool Heat lampLaundry machines: StackedLaundry machines: Front loadLaundry machines: Top loadArtwork / display shelvesPlantsSeating (bench, chairs)Wall mount hair dryer Coffee makerTelephoneCable TVCAT 5 cable for computer access OtherIf other, please explain: Color scheme:Budget: (Set a range to allow for upgraded selections)Desired start date:Desired completion date:Do you have any special requirements that would help us to ensure your desired results and a smooth process?Other comments, questions or design details: Jobsite Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeReferral Type *I am a past customerReferral (please specify)Parade of Homes Remodelers ShowcaseHome ShowOpen HouseBuilding LocationPlekkenpol Yard SignsInternet Search / WebsiteSocial MediaAdvertisementPromotional MediaDirect MailProfessional AssociationChamber of CommerceConsumer ResourceOther (please specify)Other (please specify)Referral (please specify)MessageSubmit