Questionnaire

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Virtual Showroom Tour!

Please fill out and submit the form below, so we can study your HVAC needs and give you great advice and service.

If you are human, leave this field blank.

Name *

Email *

Phone

Date *

Address

Years living in the home

Years planning to live in the home

How many years old is your furnace?
(Fill in all that apply)

Upstairs

Downstairs

How many years old is your air conditioner?
(Fill in all that apply)

Upstairs

Downstairs

What temperature is the thermostat set on?

In winter?

In sumnmer?

From 1 to 10, how satisfied are you with your comfort?

In winter?

In summer?

Are there any uncomfortable hot or cold spots?

How high does the electric bill get in the Summer?

How low does it get?

How high does the gas bill get in the Winter?

How low does it get?

Is it too dry in the Winter?

Yes

Besides filters for dust collection, do you have any products that control bacteria, viruses, mold & mildew?

Yes

Does anyone suffer from Asthma or other breathing problems?

Yes

Does anyone suffer from allergies?

Yes

Are there any unwanted odors?

Yes

Are there pets that live in the home?

Yes

Are there teenagers that live in the home?

Yes

Do you experience lingering cooking odors?

Yes

Does Anyone smoke in the home?

Yes

PLATINUM QUALITY & AIR 500

1715 Kecoughtan Rd.
Hampton, VA 23661
757-247-0500

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