Request Service Form
...Please note that all fields marked with an
*
are required.
If you don't have time to fill out the form or if you
have an emergency
,
call
1-877-4 TWIN AIR
(1-877-489-4624)
to make an appointment!
*
Name
*
E-mail
*
Telephone
*
Street Address
*
City
*
State, Zip
,
*
Type of Service Required
Please Choose
Repair Service
New and/or Replacement Equipment
Regular Maintenance
Furnace or A/C Checkup
*
How soon do you need service?
Please Choose
A.S.A.P.
This Week
Next Week
This Month
Anytime
Please choose the days and times (as many as you wish) that best fit your needs.
You will be called to confirm the actual appointment.
Morning
Afternoon
Evening
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday (When Possible)
*
Please explain, as best as possible, what your service problem or request is. Please be as specific as you can so we can complete your request quickly and efficiently.
Please provide us with the following about your heating/cooling system(s).
Primary Heating System
Please Choose
Forced Air Furnace
Heat Pump
Hot Water Boiler
Steam Boiler
Don't Know
Other
Heating System Fuel Type
Please Choose
Natural Gas
Propane (LP) Gas
Electricity
Fuel Oil
Don't Know
Other
Primary Cooling System
Please Choose
Not Applicable
Central Air Conditioning
Window Air Conditioners
Heat Pump
Don't Know
Approximate Age of Heating System
Please Choose
1-5 Years
6-10 Years
11-15 Years
16-20 Years
21+ Years
Don't Know
Approximate Age of Cooling System
Please Choose
NONE
1-5 Years
6-10 Years
11-15 Years
16-20 Years
21+ Years
Don't Know
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Yes
No, maybe later
Twin Air Heating & Cooling PO Box 94 Cheektowaga, NY 14225 Tel:1-877-489-4624
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