Outwest Air

Name *

Gender * MaleFemale

Profession

On a scale of 1-10, (with 10 being the best) how would you rate the comfort your existing system has provided? *

Do you know approximately how old your existing equipment is? *

How old is your home? *

Are any of the rooms warmer than the others in the summer or colder than the others in the winter? *
Yes
No

Which rooms?

Do you have any problems with the quality of the air in your home - dust, mustiness, odors? *
Dust
Musty Smell
Odors
Other

Do you feel your utility bills are too high compared to where you set your thermostat? *
Yes
No

If so, is it worse in the winter or the summer? WinterSummer

How do your utility bills compare to your neighbors' utility bills? *

Are there any other things you would like addressed while our comfort specialist is there?

Do you have any special requirements / circumstances?

Do you have any pets? If so, please list them.

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