Aztech Geothermal, LLC

Customer Questionnaire

Please fill out the following questionnaire and we will get back to you shortly. Thank you!

*required

Name:
*Email:
Address:
City:
State:
Zip:
Phone:

Please provide us the following information about your home:

Year built:
Total square feet:
Property size:
Largest treeless area:

Please select if the following apply to your home:

Pond on property
Well on property
Hot or cold spots in home
Home is sometimes too humid or dry
Allergy or respiratory concerns
Home has Central AC If you have AC, what is the air conditioner age: and the SEER value:

What is the fuel that is used to heat your home?

Electric Gas Propane Wood Oil

Please select if you have the following:

Forced Air Baseboard Radiators Radiant floors Window units

Please provide the average monthly or annual utility bills for the following:

Electric:
Gas:
Propane:
Oil:
Wood:

When are you planning to possibly install a Geothermal System?

6 months 1 year 5 years More

Are you aware of the impact of loop installation upon your yard?

Yes
No

Do you know anyone who has a Geothermal System?

Yes
No

Would you be interested in seeing the financing options available to you?

Yes
No

Please rate your reasons for installing a Geothermal System using the numbers 1-5:

1=Don't Care, 2=Somewhat Care, 3=Neutral, 4=Somewhat Important, 5=Very Important
Lower utility bills
Environmentally friendly
Lessen our dependence on foreign oil
Like the technology
Cleaner air in home
No noisy outside AC

Requests, questions or comments: