The Western New York Floor Company, Inc. 103 Potomac Street Rochester, NY 14611 Phone: 585.527.9400 Fax: 585.527.9403 www.wnyfloor.com 4777 Eastern Avenue Cincinnati, Ohio 45226 Phone: 800.543.1913 Fax: 513.871.7998 www.robbinsfloor.com 60 Revere Dr., Suite 500 Northbrook, Illinois 60062 Phone: 847.480.9138 Fax: 847.480.9282 E-Mail: mfma@maplefloor.org

Facility Name: Address: City: State: NY PA Zip Code: (xxxxx-xxxx) Your Name: E-Mail Address Telephone: (xxx-xxx-xxxx) Fax: (xxx-xxx-xxxx) Website Facility Specifications Is your project a new space or a renovation? New Space Renovation If a renovation, would you welcome a site visit, including a free on-site evaluation? Yes No Probable Completion Date Area 1 in Square Feet: Intended Use: Area 2 in Square Feet: Intended Use: Area 3 in Square Feet: Intended Use: Area 4 in Square Feet: Intended Use: Area 5 in Square Feet: Intended Use: Area 6 in Square Feet: Intended Use: Where did you hear about WNYFloor.com? Robbins, Inc. website Robbins, Inc. telephone MFMA website Referred by WNYF client Referred by architect Phonebook Web search General Questions or Comments *Red fields must be filled in before submission* | WNYF Home | | Our Territory | | FAQ | | Your Project |