Brooklyn, ny

Serving Staten Island, NY and surrounding areas

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Client Intake Form

Brooklyn Form

Client Information

Client Information

Client Name*

Client Address

Phone Number*

Email*

Apartment number

Suite number

What service do you need?

Residential or Commercial?

1. What type of HVAC system do you have? (Please check all that apply)

2. How many units do you have?

3. Please provide the model and serial numbers for each unit:

Unit 1

Unit 1

Unit Type

Model Number

Serial Number

Unit 2

Unit 2

Unit Type

Model Number

Serial Number

Unit 3

Unit 3

Unit Type

Model Number

Serial Number

Unit 4

Unit 4

Unit Type

Model Number

Serial Number

Unit 5

Unit 5

Unit Type

Model Number

Serial Number

Additional Units (if any)

4. How many indoor units do to u have? wall-mounted

System Details

System Details

5. What is the age of the system(s)?

6. What problem are you experiencing with the system?

How many Hvac systems at your location

Is there an access panel?

Maintenance Contract Options

Maintenance Contract Options

7. Would you like to set up a maintenance contract?

8. Would you like to schedule maintenance for your system?

9. Please provide your preferred date and time for scheduling maintenance:

Access and Service Information

Access and Service Information:

Please ensure that all indoor and outdoor units are accessible for our technicians.

Note: We charge an hourly rate for maintenance services plus materials and chemical use for cleaning, in addition to a service fee. All our work is guaranteed and performed according to manufacturer specifications.