Customer Worksheet

Name:___________________________________________________________________
Address:_________________________________________________________________
State, City, Zip: ____________________________________________________________
Phone:___________________________________________________________________

Please print out and fill in all that apply before visiting us

1. What product are you interested in?

__Stove     __Zero Clearance Fireplace     __Insert     __Gas Logs     __Glass Doors

__Mantle    __Other______________________________

2. When would you start this project?

__Immediately     __After Construction     __Next Year

3. How is this product to be used?

__Alternate Heat (sq. feet to be heated)___     __Ambiance     __Both

4. What fuel are you interested in?

__Wood     __Pellet     __Coal     __Natural Gas     __Propane Gas

5. If you are replacing a product or have an existing fireplace, how is your draft?

__Good     __Poor     __New, no experience

6. Where would the product be placed?

- Outside Wall     - Inside Wall

7. Do you have vinyl siding?

__Yes     - No

8. Measurements Needed:

Fireplace Opening  Inches

 A Front Width   _____

 B Rear Width   _____

 C Front Height   _____

 D Rear Height   _____

 E Depth    _____

 F Hearth Depth   _____

• Required for a stove – A, C, E, F
• Required for an insert – A, B, C, D, E
• Required for gas logs – A, B, E
• Required for glass doors – A, C
• Required for a mantle – A, C

9. In which area of the home are you considering adding this heat source?

___Living space (living room, dining room, kitchen, family room)
___Sleeping space (bedroom, guest)

10.  Sketch Area:  Draw a basic layout of your room or area where you are considering installation.

800-265-0585 • 978-664-0100 N.Reading, MA
866-610-7978 • 603-642-6888 Kingston, NH
866-226-4028 • 603-634-4242 Hooksett, NH

We service Massachusetts and New Hampshire only!

Rte. 28, 250 Main Street • N. Reading Massachusetts 01864
 #23 Rte 125 • Kingston, NH 03848
77 Londonderry Turnpike 28 Bypass • Hooksett, NH 03106