
| - New Vanity | Want Need |
| - Separate Shower | Want Need |
| - New Sink | Want Need |
| - Double Tub | Want Need |
| - Whirlpool Tub | Want Need |
| - New Toilet | Want Need |
| - Exercise Area | Want Need |
| - Entertainment Center | Want Need |
| - Linen Storage | Want Need |
| - Lighting Fixtures | Want Need |
| - Heat Lamp | Want Need |
| - Bidet | Want Need |
| - New Floor | Want Need |
| - New Surface Areas | Want Need |
| - New Countertops | Want Need |
| - Customized Storage | Want Need |
| - Others _________________________ | Want Need |
| ________________________________ | Want Need |
| ________________________________ | Want Need |
| ________________________________ | Want Need |
| Room Use | |
| Who will be the primary user of the bathroom? | You
Spouse Children Guests |
| Type of bathroom you wish? | Powder
Children's Master Hall |
| At times, how many may use it at the same time? | One
Two Three |
| Would you like his and her facilities? | Yes No |
| Would you prefer the toilet/bidet to be isolated from other fixtures? | Yes No |
| Would you like a closet as part of your bathroom? | Yes No |
| Do you plan to store/sort recyclables in the kitchen? | Yes No |
| What activities will be done in the new bathroom? | Bathing
Dressing Exercising Hair Care Laundry Lounging Makeup Applic. Other |
450 Riverside Avenue
Bristol,
Connecticut 06010
Toll Free: 1-800-562-1810
(860) 583-9190
Fax:
(860) 583-7833
or e-mail us at: modern@moderncabinets.com