Repair or Service for Air Conditioning and Heating Systems

Does your air conditioning or heating system need servicing or repair? Please complete and submit this form ... a service representative will contact you to schedule an appointment.

Name*
Address*
City*
State*
Zip Code*
Telephone*
E-mail*

What kind of central air or heating system do you have?
	Natural gas fired forced air (central heating)		LP gas fired forced air (central heating)
	Propane gas fired forced air (central heating)		Electric fired forced air (central heating)
	Oil fired forced air (central heating)		Heat pump
	Geothermal System		Central air conditioning
	Don't Know		Other

Why does your air conditioning or heating system need servicing?
	Annual maintenance contract		Nothing happens when it's turned on
	No heat in one location		No heat in all locations
	No air in one location		No air in all locations
	System makes odd noises		Smells funny
	Cycles On/Off too rapidly		Doesn't get warm enough
	Smell gas		Doesn't get cool enough
	Pilot light is out		Runs constantly
	Other		Leaking

Where is the furnace located?
	Attic		Garage
	Closet		Basement
	Other		Crawl Space

How old is the air conditioning or heating equipment currently being used?
	One to three years		Four to seven years
	Seven to ten years		Ten to fifteen years
	Fifteen to twenty years		Older than twenty years

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