General Information
Please input your information below and one of our Comfort Specialist Representatives will contact you soon.
Name:
Phone:
Address:
City:
State:
Zip:
E-mail:
Please enter the general information requested below so your comfort specialist can quickly assess your needs. Which of these fuels do you use in your home?
Electric
Natural gas
Propane
Fuel oil
Wood
Do you own or rent your home?
Own
Rent
What year did you move into your home?
What type of home do you have?
What type of home do you have?
Single-family detached
Townhouse/Condominium
Apartment/Duplex
Mobile/Manufactured Home
Other
What is your home's construction type?
Wood Frame
Steel Frame
Other
Including yourself, how many people live in your home?
Select the statement that best completes this sentence:
"Someone is home... "
all of the time
most of the time
some of the time
not at all
What is the heated/cooled square footage of your home?
What year was your home built?
1990 to present
1980 to 1989
1970 to 1979
1960 to 1969
1950 to 1959
1940 to 1949
1930 to 1939
1920 to 1929
1910 to 1919
1900 to 1909
before 1900
How would you describe your home's foundation?
Slab on grade
Enclosed crawl space (no foundation vents)
Open crawl space (has foundation vents)
Full basement
On average, at what temperature do you set your thermostat?
Summer
Winter
Insulation
What is the level of insulation in your attic?
Poor (0"-3" of insulation)
OK (3"-6" of insulation)
Fair (6"-9" of insulation)
Good (9" of insulation)
Excellent (10" of insulation and over)
Unknown
Are your walls insulated?
Yes
No
Are your floors insulated?
Yes
No
Window & Doors
On a windy day, which best describes the amount of air leakage around your windows?
Very drafty
Moderate air movement
No draft
What is the condition of your door's weatherstripping?
Poor
Average
Good
Which one of the following best describes the type of windows in your home?
Single pane - without storm windows
Single pane - with storm windows
Double pane - without storm windows
Double pane - with storm windows
Triple pane - without storm windows
Triple pane - with storm windows
Which one of the following best describes the type of exterior doors in your home?
Hollow wooden
Solid wooden
Insulated metal
Do you have a storm door?
Yes
No
Ducts & Sealing
What is the condition of your ducts? (Your ductwork, in the attic, basement,or crawl spaces, is the piping that carries the heated and cooled air from your unit to all of the rooms in your home. The ducts should be covered with insulation, and the joints should be taped.)
Poor
Average
Good
Unknown
Air Conditioning
What is your main source of cooling?
Central electric A/C
Geothermal heat pump
Air source heat pump
Dual fuel heat pump
Electric window/wall A/C
Evaporative cooler
Central gas A/C
Other
None
Space Heating
What is your main source of heating?
Gas furnace (forced-air) without a pilot light
Gas furnace (forced-air) with a pilot light
Gas furnace (hot water) with a pump
Gas boiler
Gas space heater (wall)
Gas space heater (floor)
Dual fuel heat pump
Electric furnace (forced-air)
Geothermal heat pump
Air source heat pump
Electric baseboard or wall units
Ceiling cable
Electric thermal storage
Other
None
Do you use a programmable thermostat?
Yes
No
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