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If you have been directed to the form by a dealer/installer, please fill this section out before going to next cell, if for yourself, please skip to next cell	Other Contact: Contact Name: Contact Company: Phone: Email: Note: The person as listed herein, will receive an email copy of your submission.
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State/Province	-- Select -- Alabama Alaska Arizona Arkansas California Coloroda Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnasota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New York North Carolina North Dakota Ohio Oklahoma Oregon Pennslyvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick New Foundland Northwest Territories Nova Scotia Ontario Prince Edward Sound Quebec Saskatchewan Yukon *
Other Countries/Continents	-- Select -- Asia Africa Central America Europe Far East Mexico Middle East South America South East Asia Other N/A If other, please state
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Nearest City to Project	-- Select -- Aberdeen Abilene Akron Alamoso Albany Albuquerque Allentown Alpena Amarillo Anchorage Annette Apalachicola Asheville Astoria Athens Atlanta Atlantic City Augusta Austin Avoca Bakersfield Baltimore Barrow Baton Rouge Beckley Bethel Bettels Big Delta Billings Binghamton Birmingham Bishop Bismarkck Blue Hill Boise Boston Bridgeport Briston/Johnson City Brownsville Buffalo Burlington Burns Cape Hatteras Caribou Casper Charleston Charlotte Chattanooga Cheyenne Chicago Chuuk Cincinnati Clayton Cleveland Cold Bay Colorado Springs Columbia Columbus Concord Concordia Corpus Christi Dallas/Fort Worth Dayton Daytona Beach Del Rio Denver Des Moines Detroit Dodge City Duluth El Paso Elkins Elko Ely Erie Eugene Eureka Evansville Fairbanks Fargo Flagstaff Flint Fort Myers Fort Smith Fort Wayne Fresno Gainesville Glasgow Goodland Grand Island Grand Junction Grand Rapids Great Falls Green Bay Greensboro Greenville Guam Gulkana Hartford Helena Hilo Homer Honolulu Houghton Lake Houston Huntington Huntsville Huron Indianapolis International Falls Islip Jackson Jacksonville Juneau Kahului Kalispell Kansas City Key West King Salmon Knoxville Kodiak Koror Kotzebue Kwajalein La Crosse Lake Charles Lander Lansing Las Vegas Lewiston Lexington Lihue Lincoln Little Rock Long Beach Los Angeles Louisville Lubbock Lynchburg Macon Madison Majuro Mansfield Marquette McGrath Medford Memphis Meridian Miami Middleton/Harrisburg Midland Milwaukee Minneapolis Missoula Mobile Moline Montgomery Mt. Washington Muskegon Nashville New Orleans New York Newark Nome Norfolk North Little Rock North Platte Oak Ridge Oklahoma Olympia Omaha Omoha Eppley Orlando Paducah Pago Pago Pendleton Pensacola Peoria Philadelphia Phoenix Pittsburgh Pocatello Pohnpei Port Arthur Portland Providence Pueblo Quillayute Raleigh Rapid City Redding Reno Richmond Roanoke Rochester Rockford Roswell Sacramento Saint Cloud Salem Salt Lake City San Angelo San Antonio San Diego San Francisco San Juan Santa Barbara Santa Maria Sault Ste Marie Savannah Scottsbluff Seattle Sheridan Shreveport Sioux City Sioux Falls South Bend Spokane Springfield Sprngfield St. Louis St. Paul Island Stockton Syracuse Talkeetna Tallahassee Tampa Toledo Topeka Toronto Tucson Tulsa Tupelo Unalakleet Valdez Valentine Vero Beach Victoria Waco Wake Island Wallaops Island Washington Washington D.C. Waterloo West Palm Beach Wichita Wichita Falls Wiliston Williamsport Wilmington Winnemucca Winslow Worcester Yakima Yakutat Yap Youngstown Yuma None of these cities match my project *
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Are you a	Home Owner Home Owner & Contractor Mechanical Contractor Electrical Contractor Geothermal Dealer Certified Geothermal Dealer Engineer Architect HVAC Distributor/Dealer Property Developer Other If other, please state
Are inquiring about:	Geothermal Heat Pumps General Open Loop Geothermal Closed Loop Geothermal Indoor Pool Dehumidification Liquid Cooled A/C Koolheat - Pool Heating System Other If other, please state
Would you like technical support?	-- Select -- Yes No Not Sure
Technical support assist areas:	Residential Heat Loss and Duct Design Residential Ventilation Installation & Design Geothermal Loop Design Potable Water Heating System (Combo) Design Residential HVAC System Commissioning Small Commercial HVAC Design Large Commercial HVAC Design EnerGuide Audits (For Canadian Customers) Code-compliance Review Air-Flow Testing and Balancing De-pressurization testing Air-Tightness testing (Blower door/Infiltrometer) Filter testing (Airborne Particulates to 0.3 cm) Data-logging of most environmental parameters Fault Investigation (We can help identify problems) HVAC System Blueprinting(Ensure things will work right)