Hot Water Recirculating System-Residence Questionnaire

Koenick Electronics Water Guardian Hot Water Recirculation Systems Residence Questionaire This is not a purchase agreement.
Answer the Questions and We'll Get Right Back To You WE GUARANTEE ALL INFORMATION YOU GIVE BELOW WILL BE HELD COMPLETELY CONFIDENTIAL!
Number of persons living in the home:		Retired? Yes No
Single Level Home or Multi-level Home
Site Built Home or Modular Home
Approximate Year the home was built:
Age of Water Heater: yrs.
Gas Water Heater or Electric Water Heater
Is there an existing 120 V Outlet adjacent to the Water Heater? Yes No

Hot Water Test
How many minutes does it take for Hot Water to reach the sink furthest from the hot water heater?: minutes.
At such time as Hot Water arrived at the sink furthest from the hot water heater did the other sink, or sinks along the way, have hot water within the last 10 seconds? Yes No
Is there an existing 120 V Outlet under the sink and inside the sink cabinet, which is furthest from the hot water heater? Yes No Is the sink furthest from the hot water heater a kitchen or a bathroom sink? Kitchen M-Bathroom Guest Bath

WE GUARANTEE ALL INFORMATION YOU GIVE BELOW WILL BE HELD COMPLETELY CONFIDENTIAL! Koenick Electronics Intl. is unable to provide your "FREE QUOTE" without completing the following information. We sometimes need to contact you to get more information. We will send your results to you, either by e-mail, by fax or by snail mail.
Name:
Address:
City:	State:	ZIP:
Telephone including area code:		FAX:
Alternate Telephone:
Best time to call: a.m. p.m.
E-mail Address:
	You must click this button in order to provide the factory Tech-Rep with sufficient information for your FREE QUOTE.
If you have any questions or need assistance please call the factory. Factory: (928) 472-9200 or (480) 732-0077 For any further questions a representative from the factory will call you from Payson, Arizona. E-Mail Us