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Comfort Analysis Request Form

Contact Information

Name:
Street:
City:
State:
Zip:
Email:
Home Phone:
Mobile:
Preferred Contact Method:	Email Home Phone Mobile Phone
Best Time to Call:
Square Footage of Home:
How did you hear about us?

Current Home & System Information

How old is your existing equipment?
How long do you plan to stay in your home?	3-5 years 6-9 years 10 or more years
On average, how much do you spend maintaining and repairing your system each year?
What is your average monthly utility bill?
Are you planning on adding any rooms or additions in the near future?	yes no
Does anyone in your home suffer from allergies, hay fever or respiratory/sinus condition?	yes no

Desired System Information

Are you considering replacing your existing HVAC system?	yes no
What type of system are you interested in?	Basic Industry Standard System (13 SEER) Better than Average System (14 SEER) Very Best System (16 SEER)
Which four of these 16 benefits are most important to you?
Quality Long Life Low Operating Cost Appearance Ease of Operation Warranty Investment Return Equipment Brand	Value Safety Quiet Operation Comfort Fewest Repairs Financing Technology Healthy Air
Is there any particular reason you chose those 4?
Would you be interested in an Indoor Air Quality System Enhancements?	yes no
Whole House Air Cleaner Condenser Tune Up/Safety Kit Mercury Free Digital Thermostat	Ultraviolet Air Treatment System Electro Static Filters Programmable Thermostat
Many of our customers prefer to finance their new system. Should you wish to finance, how much would you like the monthly payment to be?

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