CUSTOMER CONTACT INFORMATION
 * Required
Date: *
Name: *
Address: *
City: *   State: *   Zip: *
Telephone No: *
Fax No:
E-Mail address: *

What is the location of your system?
A rooftop unit       A ground unit       Do not know

What type of system do you have?
Gas / electric unit       All electric unit       Evaporative unit       Do not know

How old is your system?      Years   Months       Do not know

Is your system currently working?      Yes      No

What kind of roof do you have?
Shake       Flat       Foamed       Tile

What type of home do you live In?
Single Family       Duplex       Manufactured       Two story

How did you hear about us?
Repeat client
Referral
       May we ask whom?  
Web site
Yellow pages
Other advertising
Have attended an event
Other
Comments:
     

We'll get back to you within 12 business hours (excluding weekends and holidays).    Thank you!

Rincon Air Conditioning and Heating
4810 E. Speedway Blvd.
Tucson, AZ 85712

(520) 327-6311
E-mail:
info@rinconac.com
ROC 020039
ROC 067997