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Name*

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Phone*

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Service Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Is this a new construction?

Yes

No

Age of your home

1-10 years

11-20 years

21-30 years

30+ years

Square footage of your home

Existing HVAC System

System Type

Electric Heat Pump

Electric AC / Natural Gas Heat

Electric AC / Propane Heat

Not Sure

Other

System Age

1-5 years

6-10 years

11-15 years

16+ years

Do you have a maintenance contract with an HVAC dealer?

Yes

No

Dealer's Name

Do you have an additional HVAC at this location?

Yes

No

Additional HVAC System Information

Please list each system type and age.

Existing Water Heater Information

Water Heating

Electric

Natural Gas

Propane

Not sure

None

Tank Capacity

30 gal

40 gal

50 gal

60+ gal

On-demand

Do you have an additional water heater at this location?

Yes

No

Additional Water Heater Information

Please list each system type and age.

I would like to...

Have someone contact me for additional information.

Have a participating dealer contact me to quote a geothermal heat pump for my home.

I agree to allow Laurens Electric to share my billing information with the dealer.

I agree to allow Laurens Electric to share by contact information with the dealer.

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How It Works
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Contact Us
How You Can Save

How It Works
FAQs
Contact Us
How You Can Save

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How It Works
FAQs
How You Can Save