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Name:

Address:

Daytime Phone:

Evening Phone:

Email Address:


How many people currently reside in the home?

 

What is your time frame for this HVAC improvement?

 

How many years do you plan on staying in your home?

 

What is the approximate age of your current system?

 

Do you have any pets?

   Yes      

No

Are there any smokers in your home?

   Yes      

No

Do any members of your family suffer from allergies, asthma or other respiratory problems?

   Yes      

No

Are your heating and cooling bills too high?

   Yes     

No

Are there any rooms in your home that are always too cold or too hot?

   Yes      

No

Is your indoor unit or outdoor unit (or both) too noisy?

   Yes      

No

Do you have a problem with humidity in the summer or dry air in the winter?

   Yes      

No

Does your furnace short cycle, constantly turning off and on?

   Yes      

No

 

What is most important to you when
choosing a company to do business with?

  

Please submit the following information and a representative will contact you shortly.   




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