Company Information

Fields marked with an * asterisk are required to submit this form online.

Name of Company, facility or organization:

*Contact Name:

Contact's Title:

Contact's Street Address:

Contact's City:

Contact's State:

Contact's Zip Code:

*Contact's Phone:

*Contact's Email:

Current Utilities Company Information

*What utilities company provides power to your organization? (Example: Duke Power, Progress Energy):

*Account Number:

*Last four digits of your Tax ID?:

* (Please feel free to call us to give this information. - This information is necessary to complete the analysis.)

Primary HVAC Information

Service Company Name:

Contact's Name:

Contact's Phone:

Contact's Email:

How many HVAC Units does the facility have: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 17 19 20 22 23 24 25 25+

How many Chillers? 1 2 3 4 5 6 7 8 9 10 10+

Please provide a thorough schedule of the daily activities of the facility

When does the facility operate (business hours and/or production hours)? 7 days 5 days Other

Is the facility occupied and operational on the weekends? Yes No

Is the facility operating at capacity? Yes No

Facilities Supervisor's Name:

Facilities Supervisor's Phone:

Facilities Supervisor's Email:

Facilities Engineer's Name:

Facilities Engineer's Phone:

Facilities Engineer's Email:

Facilities Square Footage?:

Referred by: