Request service Contact Info -

required fields are marked with an asterisk *

*

NAME

COMPANY

*

ADDRESS

*

CITY

*

STATE

*

ZIP CODE

*

COUNTY

*

PHONE

FAX

*

EMAIL

*

The best DAY to contact you:

*

The best TIME to contact you:

---

*

What kind of problem are you experiencing?

(required) Residential Electrical Residential Heating Residential Plumbing Residential Air Conditioning Commercial Refrigeration Commercial Electrical Commercial HVAC Commercial Plumbing

*

IS THIS AN EMERGENCY SITUATION?

(required) YES No

---

The following sections are optional - but they will help us to help you

Furnace information:

Manufacturer

Model

Approximate Age

Type

.... Natural Gas Propane Fuel Oil Electric

---

Water Heater information:

Approximate Age

Type

.... Natural Gas Propane Fuel Oil Electric

---

Electrical Panel information:

Manufacturer

Model

Approximate Age

Amps

Meter Number

---

Generator information:

Manufacturer

Model

KW (kilowatts)

Fueled by

.... Natural Gas Propane Diesel Gasoline

Transfer switch?

.... Yes No

---

Additional information or comments:

---

*

Security Code:

---

Copyright © 2007 BC Plumbing, Heating, Electrical, AC/R, Inc.