Part I - General Information

Name of Structure:

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Age of Structure:

Function of Structure:

-- pick one -- Church Church Hall Community Centre Civic Admin Residence Commercial Other Function

Denomination: (if Church)

-- pick one -- Adventist Alliance Anglican Antiochian Orthodox Assembly Baha'I Baptist Bible Buddhist Catholic Chinese Alliance Christian Christian Assembly Christian Fellowship Christian Reformed Christian Science Church of Christ Community Congregational Coptic Orthodox Covenant Evangelical Fellowship Gospel Greek Orthodox Hindu Temple Jehovah's Witnesses Jesuits Latter Day Saints Lutheran Martyrs Mennonite Missionary Bible Mormon Nazarene Non denominational Orthodox Pastoral Pentecostal Presbyterian Protestant Quakers Science Fellowship Scientology Sikh Synagogue Unitarian United Wesleyan Other

Address:

City:

Province:

Nova Scotia New Brunswick Prince Edward Island

Postal Code:

Country:

Phone:

Fax:

Cell Phone:

Part II - Contact Information

Contact Person:
  (First and Last name)

* (required)

Contact Person:
  (Phone evenings)

Contact Person:
  (email)

* (required)

Part III - Building Information

Architect:

Building Type:

-- pick one -- Wood Stone Brick Metal Other

Additions/Renovations:

Number of Windows:
   (figurative)

Approx. Age:

Number of Windows:
   (ornamental)

Approx. Age:

Number of Windows:
   (ornamental painted)

Approx. Age:

Number of Windows:
   (plain)

Approx. Age:

Do you have exterior protection on your stained glass?

  Yes:
  No:  

How efficient would you say your interior lamps are?

  poor:         medium:         good:

Are you interested in a stained glass window appraisal free of charge?

  Yes:
  No:  

Do you have a website?

URL:

(Case sensitive !)
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