Brock Builders Inc.

	Please answer the following brief questions and let us know where you are in the building process:
	Items with an * are required.

	Do you have architectural plans? Yes No		Do you have your building lot? Yes No

	Are you interested in a Custom Home or Renovation? Custom Home Renovation		What time frame are you planning? Immediately 3-6 Months 6-12 Months

	Do you want someone to contact you? Yes No		How can we best reach you? Phone Email Post Mail

	* Name		* Street Number and Name

	* City		* Prov/State

	* Postal / Zip Code		* Phone

	Cell Phone		* E-mail