ACR Sales & Services, Inc.

This is a FREE Home Energy Evaluation
from ACR and you are not obligated
to make a purchase.

Fill out the following information completely.
Be sure to include your phone number and
e-mail address.A customer service representative will call for an appointment.

Energy Survey Form
Name
Address
Mailing Address
State
Zip
Home Phone
Work Phone
E-Mail Address
1. Home was built in: 2. Moved into home? 3. Number of people living at home? 4. Own or rent: Rent Home Own Home 5. Thermostat is set at: Summer Winter 6. Thermostat is: Manual Programmable 7. Condition of our ducts are: Poor Average Good Unknown 8. Wall Insulated: Yes No 9. Floors Insulated: Yes No 10. Attic Insulated: Yes No 11. Home fuel type: Wood Electric Natural gas Fuel oil Propane 12. Type of home? Detached single-family Townhouse/Condominium Apartment Duplex Manufactured Home/Mobile Other 13. Construction type? Wood Frame Block Other 14. Foundation: Slab Enclosed crawl space Open crawl space Basement 15. Type of windows: Single pane Double pane Triple pane 16. Do you have storm windows? Yes No 17. Type of exterior doors in your home: Hollow wood Solid wood Insulated metal Fiberglass 18. Do you have a storm door? Yes No

ACR Sales and Service, Inc.
3509 All American Blvd
Orlando, FL 32810

Lic. #CA-C035517

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