Date:

Name:

Address:

City & Zip Code:

Phone Number:

Email Address:

Gender:

: Male
: Female

Age:

20-29 yrs 30-39 yrs 40-49 yrs 50-59 yrs 60-69 yrs 70+ :

What changes would you like to make to your wardrobe?

What colors do you most frequently wear?

What are your favorite wardrobe pieces?

What features would you like to camouflage?

What features would you like to accentuate?

Do you have a clothing budget you would like us to work with?

Which best describes your personal style?

Classic/Traditional Feminine/Girlie Trendy/Contemporary Casual/Practical :

Do you have any areas of interest or concern?