Planning on building in the near future? Fill in the form below and submit it to us.
We will respond to your request promptly.
or if you just have a comment about our site,
Send Us a Note!
Contact Name:
Company Name: (if applicable)
Street Address:
City/State:
Zip+4 Code:
-
Phone Number:
-
-
E-mail:
How would you like us to contact you?
Phone
E-mail
If you prefer that we contact you by phone, what is the best time to reach you?
Morning
Afternoon
Evening
What type of project(s) are you inquiring about.
(Select all that may apply.)
Commercial
Shopping Center
Medical
Professional Offices
Industrial
Food Store
Restaurant
Residential
Other
How soon do you plan on starting construction?
1 Month
6 Months
1 Year
2 Years
What type of construction will this be?
New Construction
Renovation
Is there anything important you would like us to know about your project?
T E L L
....
U S
....
W H A T
....
Y O U
....
T H I N K
....
O F
....
O U R
....
S I T E
How did you locate our site?
Link from another site
Friend
Internet Search
Construction Site
Other
Do you have any comments or suggestions regarding our Web site?
Thank You!
Just click the
SEND
button if you are finished
or
click RESET to start again.
If you have any problems sending this form, you can print it, complete it,
and mail or fax it to us at:
MURRAY JAY MILLER - ARCHITECTURE
138 South Main Street
Wilkes-Barre, PA
18701-1601
Our fax number is:
(570) 822-4546
