Chiarini Marble & Stone  Just print out this FAX Form
Fax to 714-547-7282 www.chiarini-marble.com
First Name:
Last Name:
Address 1:
Address 2:
City:
State:
Zip Code:
Day Phone:
Night Phone:
Fax:
E-mail:
Contractor:
 
Fire box is:
 (Please Check)
Metal
Masonry
 		 Measuring in:
 (Please check)
Inches
Centimeters
 
A: Width of firebox  
 
B: Height of firebox  
 
C: Height from floor to firebox  
 
D: Right hand distance from firebox to nearest obstacle  
 
E: Left hand distance from firebox to nearest obstacle  
 
F: Height from floor to ceiling  
 
GL: Left gas valve position off floor  
 
GR: Right gas valve position off floor  
 
H: Depth of firebox  
 
I: Height from firebox to ceiling  
 
Yes  No
Does your wall pop out?     
Any plug outlets on either side?     
Anything unusual?     
Please Explain:
If you have any questions, please contact us at 714-547-5466
 
This form may be printed out and faxed to us at 714-547-7282
Special Requests?
Best time to call?
Room Type:
Bedroom #:
Fireplace Style:
Stone Type:
Date Measured:
Estimated Delivery:
Designer:
www.chiarini-marble.com
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