Air Quality Survey

About You...

* Indicates Required Field

Name

*First	*Last

*Address

City/State/Zip

*City	*State	*Zip

*Telephone

*E-mail Address

1) Do cooking or other odors tend to linger in your home?

Yes

No

2) Does anyone in your family suffer from allergies, asthma, or breathing difficulties?
Yes	No

3) Does anyone in your home smoke?
Yes	No

4) Do you have indoor pets?
Yes	No

5) Do you ever suffer from dry throat, dry skin, or experience static electricity in your home?
Yes	No

6) Do you tend to use antibacterial household products like cleaners or soap?
Yes	No

7) Have you ever purchased or used portable (plug-in) room air cleaners or humidifiers?
Yes	No

8) Do some areas of your home experience dramatic temperature differences(i.e. too hot upstairs, too cool downstairs)?
Yes	No

9) Is your thermostat programmed for energy savings?
Yes	No

10) Has it been a year or more since you had your heating and cooling system cleaned and inspected?
Yes	No

Puron-The Environmentally Sound Refrigerant

Hybrid Heat Systems

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