Client In-take Form

First Name *

Last Name

Email *

Phone

Interested In

Kitchen

Furniture

Closet

Others

Type of client

Organization

Address

City

Province

Country

Where did you hear about us?

Do you agree to receive marketing communication from us? *

Sales Rep *

I agree to terms & conditions provided by the company. By providing my phone number and email, I agree to receive emails from the Poliform Vancouver team regarding my inquiry and related further communication.