Residential Information Form

How would you like to be contacted?

Please send me information in the mail
Please contact me via email
Please contact me via telephone

1. Contact Information

   Email
   Name
   Address
   City
   State
   Zip
   Home Phone
   Fax

    

2. Please provide the following Residential information:

   Style of home: Choose One... Ranch 2-Story Mobile Home Other           Square Footage of Home:  Ft Sq
    

   Primary Energy Source  Choose One... Natural Gas Electricity Propane
   Inlet Water Temperature (degrees F): Choose One... less than 40 40-50 50-60 60-70 greater than 70   

   Water Source: Choose One... City Water Well Water

   Preheated by solar? Yes No

   Primary Use:   Choose One... Home Business Commercial Restaurnat

   Outlet Temperature Desired (deg F):
   (Typical shower temperature is 105 to 110 Deg F)

   How many shower heads would you like to run simultaneously?     Choose One... 1 2 3 More than 3

   Does your shower have Multiple Shower Heads or a Body Spray system?      Yes   No  

   If yes, what are the total gallons per minute your system uses?:                    GPM

   Do you run a whirlpool bathtub? Yes    No

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   Service Questions:

   Electrical Service: Choose One... Less than 100 Amps 100 Amps 100-150 amps 150-200 Amps More than 200 Amps

   Natural Gas Service