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Name
E-mail Address
Zip Code

(Optional Information)
Street Address
City / Town
State / Providence
 
Country
Home Tel.#
(include area code)
Company Name
Title
Work Tel. #
(include area code)
Fax Tel. #
(include area code)
Web Site URL

Room Evaluation

Room Environment
Room Volume
Seating
(From Speakers)
Treatment
Straight Wire HARD ROOM
Hard: Plaster walls, lots of glass, little furniture, tile floors.
Straight Wire MEDIUM ROOM
Medium: Drywall, some glass, moderate furniture, art on walls, rugs.
Straight Wire SOFT ROOM
Soft:
Drywall, little glass, big soft furniture, carpeting, open space.

System Components
Blu-Ray / DVD Source

(If "Other" enter name below)

Model #

Cable / SAT Source

(If "Other" enter name below)

Model #

Other Source

(If "Other" enter name below)

Model #

Receiver/ Pre-amp
AV Receiver

(If "Other" enter name below)

.

Model #

 Power Amp

(If "Other" enter name below)

.

 Power Amp Model #


Flat Panel TV

(If "Other" enter name below)

  Model #

Projector

(If "Other" enter name below)

Model #

LR Speakers

(If "Other" enter name below)

 Model #

Center Speaker

(If "Other" enter name below)

Model #

Surround Speakers

(If "Other" enter name below)

Model #

Subwoofer

(If "Other" enter name below)

.

 Model #



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