HydroSolution

Application to purchase a heating unit

Items marked with an asterisk (*) must be completed

You must own the premises to purchase a heating unit.

1.1

Your first name

1.2

Your last name

1.3

Telephone number

to contact you between
9 a.m. and 6 p.m. weekdays

(

)

ext.

1.4

Other number

(

)

ext.

1.5

Other number

(

)

ext.

1.6

E-mail

1.7

Home address

1.8

City

1.9

Postal code

Energy sources used

2.1

Energy sources used

Other (specify):

2.2

Heating system(s) used

	Baseboard heaters	Hot air (furnace)	Central heat pump
	Convectors	Hot water (boiler)	Radiant floor or ceiling
Other (specify):

2.3

Heating system age

Heating unit of interest

2.4

Heating unit of interest

2.5

Type of home for installation

Other (specify):

2.6

Address to install
(if not home address)

2.7

City

2.8

Postal code

2.9

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