Order Form

ISSUE:

Are you reaching out regarding residential or commercial services?

Please select your issue:*

Heating & Cooling:*

No Heat

No Cooling

Thermostat

Unit Leaking Water

Unit Making Noise

Unit Not Turning Off

Other HVAC Issues

Is your system operating properly at this time?*

Yes

Estimates:*

Heating

Cooling

Indoor Air Quality

Water Heaters

Other

DETAILS:

Are you the homeowner or a person authorized to pay for repairs at this address?*

Yes

What type of system do you have?*

Heat Pump

Ductless/Mini Split

Furnace

Radiant

Other/Not Sure

What type of system do you have?*

Central Air

Ductless/Mini Split

Other/Not Sure

What type of system do you have?*

Central Air

Ductless/Mini Split

Other/Not Sure

What type of system do you have?*

Central Air

Ductless/Mini Split

Other/Not Sure

Is your heating / cooling system working properly?*

Yes

Is the display lit?*

Yes

Is your system turning on as expected?*

Yes

No, intermittently

Where is the leaking unit located?*

Attic

Basement

Upstairs

Garage

Main Floor

Outside

Other

Please turn unit off

Thank you for choosing Harker Heating & Cooling. Please call us at (608) 480-6334 to book your appointment.

What is the approximate age of your system?*

Less than 5 years old

6 to 9 years old

10 to 15 years old

Over 15 years old

Not sure

What type of energy does it use?*

Electric

Water to Air

Gas/Propane

Not Sure

Where is the noise coming from?*

Inside

Outside

Is your system running properly?*

Yes

How many units need to be serviced?*

One

Two

Three

Four

Is your current system performing normally?*

Yes

How old is your System?*

Less than 5 years old

6 to 9 years old

10 to 15 years old

Over 15 years old

Not sure

Please provide as many details as you can on the following two screens:*

Tell us more about your issue. Provide Details about your Issue here:*

Is you thermostat operating as it should?*

Please provide detail about your issue on the following two screens:*

Tell us more about your issue. Provide Details about your Issue here:*

Upload a video or photos?

Drop files here or

Accepted file types: jpg, gif, png, jpeg, mp4, mov, avi, Max. file size: 256 MB, Max. files: 4.

Not required, but a short video of the problem is the best way for us to assign the best technician and send the right equipment. You can also upload photos. Drag and Drop Your Photos and Videos Here, or Click to Browse

Tell us more about your issue:

Have we served you in the past?*

Yes

CUSTOMER:

First Name:*

Last Name:

Phone:

Email:*

Zip Code:*

Address:

Street Address City State ZIP / Postal Code

Consent:

I own this property

CONFIRM:

Consent:*

I accept the terms of booking.

Due to the complex nature of most mechanical issues, it is usually best you reach out to us by phone to answer your questions.

What to expect when you submit this form: Please expect one of our team to get back to you within 24hrs if you have reached out to us during normal business hours.

If this is an emergency situation and you need help/service right away, the absolute best and most efficient way to meet your needs is to call us at 608 255 6902. You can request emergency service through this phone number.

Thanks again for reaching out to us. We realize you have many choices in the area, and please look forward to us getting back to you as soon as we can.

Harker Heating & Cooling

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ISSUE:

DETAILS:

CUSTOMER:

CONFIRM: