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Your Name * Required Title Company Address City State   Zip Code Business Phone (Day Phone) * Required Fax E-mail * Required Choose one of the following options: Please send literature and have a salesperson call Please send me information Choose the option that best applies to you: Moving to new building or facility Remodeling existing center Replacing Chairs How soon do you plan on purchasing? Within the next 30 days 1-3 Months 3-6 Months 6-12 Months What brand of chair are you currently using? Where are you purchasing your chairs now?   Number of chairs Number of positions Choose the option that best applies to you: Looking to purchase for personal/home use Looking to use for Commercial use Looking to become a Dealer/Distributor Architect/Consultant/Integrator Special needs. check all that apply: Extra height needed (bar stool height) Very large people Very petite people ( 5' 1" and under ) Problems to overcome (check all that apply:) Chairs breaking down too quickly Not getting good service from current vendor Seeking better ergonomics/comfort What is the biggest problem to overcome or improve? (chairs breaking, etc.)   How did you hear about Concept Seating Inc.? Word of Mouth 911 Magazine PoliceOne.com Internet Search Trade Show Direct Mail I already own a chair Additional comments or pertinent information? Thank you! Thank you!