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•••IN-HOME SALES CONSULTATION REQUEST

Please fill out the following form as completely as possible.
On the next business day you will receive confirmation by e-mail or phone, whichever you prefer.

*Required Fields

First Name	*
Last Name	*
Address
City
State
Zip
Day Time Phone #	*
Night Time Phone #
Email Address	*

How would you like to be contacted to confirm this appointment?

Email
Phone

What comfort products are you interested in?

Furnace

Air Conditioner

Air Cleaner

Radiant Heat

Heat Pump

Please indicate what type of system you have?

Heat/Air - Forced Air	Heat Pump
Heat - Forced Air	Hot Water
Air Cond - Forced Air	Steam

Please indicate what type of fuel you currently have?

Natural Gas	Oil
Propane	Electric

Please provide two options for your consultation. Date and time of day?

Option One	Option Two
Date (mm/dd/yy)	Date (mm/dd/yy)

Time of Day / 00:00 am/pm	Time of Day / 00:00 am/pm

I would prefer my appointment.

8am - 12 noon

12 noon - 5 pm

Do you have any comments, questions or requests?

Please enter the Security Code as above:

TIP OF THE DAY

Saving Energy! WINDOWS

Do you know that up to 25% of your heat can go out the window?

Here's what you can do:

• Use caulking and weather stripping to stop much of the heated air from escaping.

• Replace single-thickness windows with thermal-type double thickness windows.

• Install storm windows and doors to provide additional insurance against heat loss.

• Add window insulation kits which uses double-sided tape, clear plastic and a hair dryer.

:: land ::
Piedmont Mechanical Contractors Inc.
804 Garmond Park Court.
Loganville, Ga. 30052

:: line ::
tel 770.554.7674
fax 770.554.7671

Serving Metro Atlanta
GA LIN. CR109286