How to use this form: Print the form out, fill in as much information as you can, transfer it to this form online and click submit to email the form to us. Or print out the form and fax it to 888 292-2088. One of our representatives will process the information and contact you.

* Denotes required fields

* Is the floor of your firebox flush with the top surface of your hearth or floor? Yes     No 

If answering no, the height it is raised is inches

A.   Firebox opening height (Physical Hole) inches

B.   Firebox width (Physical Hole) inches

C.   Surround height (brick, marble, tile, etc.) inches

D.   Surround width (brick, marble, tile, etc.)  inches

E.   Distance from opening to edge of surround material, inches on sides, inches on top.

F.   Depth or thickness of surround material  inches

G.   Hearth height  inches

H.   Hearth width  inches

I.   Hearth depth  inches

J.   Distance, on left, from surround to nearest obstruction (wall, door, window, etc.)  inches

K.  Distance, on right, from surround to nearest obstruction (wall, door, window, etc.)  inches

L.   Wall width  inches

M.  Distance from floor to ceiling (under crown molding)  inches

A. About your home

1.  New construction or adding on.

2.  Fireplace built

3.  Existing home fireplace. Approximate age of home  years.

4. Number of rooms with fireplaces

5. Number of mantels required

6. Approximate square footage of home

B. About the fireplace

1. Type of firebox masonry or prefab unit

2. Type of wall at fireplace brick, drywall, plaster, rock, other

3. Kind of fuel wood, gas logs, false fireplace

C. About the room

1. Kind of room living room, dining room, bedroom, den, other

2. Dimensions of room

3. Kind of trim painted, natural wood - stain color

4. Describe the room formal, informal, country, traditional, other

5. Kind and color of furniture in the room

D. Kind of mantel you prefer (check all that apply)

1. Type of mantel Shelf only, Half mantel with no mirror, full mantel with mirror

2.  Stain grade or paint grade

3. Type of wood poplar, quarter sawn oak, cherry, mahogany, heart pine, other

4. Style of mantel Plain/simple, fancy/ornate, Formal/stately, Delicate, Massive

E. How did you hear about us?  (check all that apply)

1.  From a satisfied customer who purchased a mantel from us

2.  From a friend or relative who has visited our shop

3.   From a friend or relative who saw Mantels of Yesteryear's display at a trade or home show

Name of show

4.   From an architect builder designer who saw Mantels of Yesteryear in a source book

Name of book

5.  From an advertisement or billboard

Name of publication

6.   Just happened to see our shop and stopped to visit and look

7.  Phone book

Name of book

8. Other

For the fireplace of:

* Name:

 Address:

 City, State, Zip

 Home Phone:

 Business Phone:

 Business Fax:

* Email:

Best time to reach you

Is there a style that you would like to consider? Model Number(s)