The following survey was designed to assist you and your family in achieving “Absolute Home Comfort.” Please take a few moments to fill in not only the required fields *, but all fields that may apply to you and your home. After submitting this form, allow 3-5 business days to process and review your answers, at which time a member of Absolute Home Comfort will contact you to schedule your free consultation. Thank you.

Contact Information

Name (required)
 Your Email (required)
Address
City
 State
Zip
 Phone

General Information

How Long have you lived in your current home:

How many of you live within your home:

Adults

0 1 2 3 4 
Children

0 1 2 3 4 
What is the Approximate Living Space:

 Under 1,000 1,000 to 1,500 SF 1,500 to 2,000 SF Over 2,000 SF
How old is your home:

 Under 10yrs. 10 - 25 Yrs. 25 - 50 Yrs. Over 50yrs.
How many levels do you have: (not including basement):

 1 2 3 4
Is your home a:

 1 Family 2 Family 3 Family 4 Family
Is your basement:

 Finished Un-Finished
Is your attic:

 Finished Un-Finished

Heating

My Primary heating system is:

 Steam Forced Hot Water Forced Hot Air Electric Baseboard Heat Pump
Approximate Age:

 Under 2 yrs. 2 - 5 yrs. 5 - 10 yrs. 10 - 15 yrs. 15 Plus yrs.
My primary heating fuel is:

 Oil Gas Electric
I am interested in:

 Oil Gas Electric
Does your home heat evenly:

 Yes No
Are there any strange noises:

 Yes No

Please Explain:
How many thermostats do you have:

 1 2 3 4 5
How many filters do you have:

 1 2 3 4 5
How many times per year do you have your heating system inspected:

 1 2 3
Are you interested in maintenance agreements:

 yes no

Cooling:

Do you have Central Air Conditioning:

 Yes No

If No, are you interested in getting A/C?

 Yes No
Where is your System located:

 Attic Basement Crawlspace Closet
Approximate Age:

 Under 2 yrs.  2 - 5 yrs. 5 - 10 yrs. 10 - 15 yrs. 15 Plus yrs.
Are there any strange noises:

 Yes No

Please Explain:
Does your home cool evenly:

 Yes No
How many thermostats do you have:

 1 2 3 4 5
How many filters do you have:

 1 2 3 4 5
How many times per year do you have your heating system inspected:

 1 2 3
Are you interested in maintenance agreements:

 Yes No

Home & Family

Is woodwork in your home cracked and/or split?

 YES NO VERY SOMEWHAT NOT AT ALL

Are your doors and windows difficult to operate?

 YES NO VERY SOMEWHAT NOT AT ALL

Do your exterior doors and windows have drafts and light showing around their edges?

 YES NO VERY SOMEWHAT NOT AT ALL

Does condensation form on windows and sky lights?

 YES NO VERY SOMEWHAT NOT AT ALL

Is your basement damp and or taking on water?

 YES NO VERY SOMEWHAT NOT AT ALL

Mold is/has been present in your home?

 YES NO VERY SOMEWHAT NOT AT ALL

Are you constantly adjusting the thermostat?

 YES NO VERY SOMEWHAT NOT AT ALL

Does anybody have any respiratory problems or allergies?

 YES NO VERY SOMEWHAT NOT AT ALL

Does anybody in your home suffer from nose bleeds?

 YES NO VERY SOMEWHAT NOT AT ALL

Does anybody in your home suffer from chronic congestion and flu-like symptoms?

 YES NO VERY SOMEWHAT NOT AT ALL

Does sickness often effect your family?

 YES NO VERY SOMEWHAT NOT AT ALL

If so, does the sickness typically spread throughout your entire family?

 YES NO VERY SOMEWHAT NOT AT ALL

Do you have any pets?

 YES NO VERY SOMEWHAT NOT AT ALL