Full Name

Address

City

State

Zip

Phone

Email

Was our office staff helpful and coureous?

Were your questions answered satisfactorily?

Did our technician arrive at the estimated time?

Did our technician greet you pleasantly?

Is his appearance satisfactory?

Is our technician courteous?

Does the humidity affect anyone in the home during the summer?

Does anyone in your home suffer from allergies?

Do you have to dust often?

Is there ever a damp or musty odor in your home?

Would you like to receive a discount on today’s call?

What is approximate age of your cooling system?

What is the approximate age of your heating system?

Which rooms in the house are the least comfortable?

What is your typical electric bill?

Summer

Winter

What is your typical gas/oil bill?

Summer

Winter

What do you not like about your present heating and cooling system?

Additional Comments

Please rate our service on a scale of 1–10 with 10 being the highest: