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Ebony Office Interiors LLC - Client Survey

 

Personal Information
Who referred you to this survey:
*First Name:
*Last Name:
*Email:
Company:
Street Address:
Office Number:
City:
State:
Postal Code:
Phone:
Fax:
Specific Fitting Data
Your Weight:
Hip Width (while seated, measure from hip to hip):
Your Height:
Femur length (middle of hip to middle of knee):
Hours you sit per day:
Lower leg length (from mid knee to floor):
Which type of computer system do you use?
Are you currently discomforted by a physical ailment?
If yes, please explain:
General Comments:
  
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