1.
Enter your Full Name:
2.
Enter your Email Address:
3.
Your Home Telephone:
4.
Street Address:
5.
City/State:
, NC
6.
Zip/Postal Code:
7.
Best time to Reach You:
Please Choose One Anytime 8:00am - 10:00am 10:00am - 12:00pm 12:00pm - 2:00pm 2:00pm - 4:00pm 4:00pm - 6:00pm 6:00pm - 8:00pm
8.
Best Day for us to visit you:
Please Choose One Monday's Tuesday's Wednesday's Thursday's Friday's
9.
Are you interested in purchasing soon?
Please Choose One Yes Not Now Maybe Not Sure
10.
Customer Type:
Please Choose One New Customer Service Contract Customer Comfort Plus Customer Past/Existing Customer Not Sure
11.
Will all the decision-makers be present for the proposal?
Yes No
12.
What type of equipment do you have now?
Please Choose One None Gas/GasPak and Air Oil/Boiler Fired with Air Heat Pump Electric Other
13.
How old is existing equipment?
Please Choose One Less than 5 years old 5- 10 years old 10-15 years old 16-20 years old Over 20 Years old
14.
What type of equipment would you like?
Please Choose One To be Discussed Heat Pump Gas / Gas Pak AC Only Furnace Only Electric Oil / Boiler Other
15.
Do you have a bad compressor?
Please Choose One Yes No Not Sure
16.
Do you have a cracked heat exchanger?
Please Choose One Yes No Not Sure
17.
Please provide us with any additional information you think we should know about in order to better serve you: