Water Heater Questionnaire

Please complete our water heater questionnaire to prepare for installation.

Customer Name*
Customer Work Performed Address
Street Address Address Line 2 City State ZIP Code
Customer Billing Address (if different)
Street Address Address Line 2 City State ZIP Code
Phone*
Water Heater Manufacturer
Model #
Serial #
Warranty Expired Date
MM
DD
YYYY
House or Condo?
Location (Basement/Closet/Floor)
Is the area around/near and to water heater easily accessible?
Entrance Accessibility
Gas or Electric?
Vented to chimney or power vented (outside wall)
C.O. Detector
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Online Request Form