20 Lenox Avenue, East Stroudsburg, PA 18301

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HVAC Install Pre-Appointment Form

Residential Comfort Survey

Please fill our the information to the best of your ability. Our Heating and Cooling Specialist will contact you regarding any additional information required.

Contact Us

First Name

Last Name

Email

Phone Number

Street Address

City

State

Zip Code

Comfort Needs Analysis

COMFORT NEEDS ANALYSIS

How long have you lived in the home?

How many members live in your household?

Future plans for the home

How are you heating the home now?

How old is the current system?

Are there any hot/cold areas in the home? If so, where?

Does anyone in the home suffer from asthma, allergies, hay fever, etc?

Yes

No

What does you average utility bill cost?

Have you done any research or had any other estimates?

When are you looking to start this project?

Additional notes or information that you would like to provide:

Mechanical Information

MECHANICAL INFORMATION - Property Details

Year Built

Sq. Feet

Utility Company

Crawlspace

Yes

No

Height of crawlspace

Lights in crawlspace?

Yes

No

Crawlspace Access Type

Crawlspace Access Size

Basement

Type of Ceiling

Basement Access Type

Basement Access Size

Attic Space

Yes

No

Attic Height

Attic Lights

Yes

No

Attic Access Type

Attic Access Size

Existing Equipment

EXISTING EQUIPMENT

Existing Unit Type

Indoor Unit Location

Existing Duct

Duct Location

How many Supplies?

How many returns?

Filter Location

Filter Size

Humidifier

None

Remove

Replace

Keep

Condensate Pump

Yes

No

Where does the condensate pump drain?

Refrigerant Line Set (runs from indoor unit or coil to outdoor unit)

Thermostat

Replace

Keep Existing

New Field:

Number of Thermostats

Equipment/Brand/Model #

Equipment/Brand/Model #

New Field:

Air Handler Model # (indoor unit)

New Field:

New Field:

Furnace/Boiler Brand (indoor unit)

Furnace/Boiler Model # (indoor unit)

Coil Brand (attached to furnace)

Coil Model # (attached to furnace)

Electrical Details

Electrical Details

Electric Panel Location

Electrical Panel Size

100amp

200amp

Other

New Field

Outdoor Unit Breaker Size (found in electrical panel)

Additional Information Boilers/Gas

Additional Information Boilers/Gas

Style

Heat Source

Flue Location

Flue Type

New Field:

Gas Water Heater

Yes

No

New Field:

Oil/Gas Tank Location

Tank Condition

Gas Type

Gas Pipe Size

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LOCATION

20 Lenox Avenue

East Stroudsburg, PA 18301

#PA120236

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