Commercial / Industrial / Residential
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H.V.A.C.R. (Heating, Ventilation, Air Conditioning, Refrigeration)
Electrical, Plumbing, Specialty Service / Installation Contracting

Service Request Form

(Fill in the form with as much information as possible and we will have a representative contact you)

How urgent is the job or service? (Please select)

Budgeting Next Month Next Few Days Please Contact ASAP  Emergency

Are you looking for install price, repair/service or replacement?

Other:

If Repair/Service or Replacement please indicate as much information on your heating/cooling system below

Type of Equipment:                                                                      Type of Fuel for Heating:

                                 

Please describe the kind of work or service you are looking for:

Contact Information: (Please fill out as much information as possible)

Company Name (if applicable)
Contact Name
Address (Street, Rd.)
City, Town
State
E-mail
Telephone # Home
Telephone # Work
Telephone # Cell Phone
Fax #
Do you own the home/building/facility?
Best Time to Contact You

How do you prefer to be contacted? (Please select)

Phone (Home) Phone (Work) Phone (Cell)Email Mail
 

Please contact me as soon as possible regarding this matter.

Note:  If you require immediate service please call our 24 Hour - 7 Day Live Person Answering Service for further assistance - 203-269-1600 - Please make sure to note whether it is emergency or if you want service the next day.  The on-call technician will contact you as soon as possible, typically less than 15 minutes and will let you know the response time based on location etc.. typically less than 2 hours for emergency!!

Our office normal hours are 7:00a.m. - 5:00pm - Our normal office hours are 7:00am - 5:00pm (M - F) 

 
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Copyright © 2005 Climatech Mechanical Services.  All rights reserved.
Revised: 06/26/07.