What type of equipment are you repairing?

Air Conditioner

Furnace or Boiler

Gas/Electric Packaged Unit

What is the age of your equipment?

Less than 6 years

6-10 years

11-20 years

Over 20 years

Do not know

What is the estimated cost of needed repairs?

Less than $100

$100-$500

$500-$1000

Over $1000

Is the equipment still under warranty?

Yes

No

What is the SEER Efficiency rating of your equipment?

14 and over

11-13

8-10

5-7

Type of refrigerant used?

R-410A

R-22

Has the air conditioner compressor been replaced recently?

Yes

No

What is the AFUE Efficiency rating of your equipment?

Over 90

87-90

80-86

70-79

Has the heat exchanger been replaced recently?

Yes

No

Does your equipment turn on and off repeatedly during the day?

Yes

No

Do you have problem rooms that never seem to get warm or cool?

Yes

No

Is the turning on of you9r equipment noticeable, disturbing, or causing annoying vibrations in your home?

Yes

No

How long do you expect to stay in this home?

Less than 2 years

2-5 years

6-10 years

Over 10 years

Name *

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you an existing customer?

Yes

No

When can we contact you?

Daytime

Evening

Anytime