When would you like us to visit (
testing
)
Day
*
(Mon-Fri):
Time
*
:
morning (8am - 12 noon)
afternoon (12noon - 5pm)
Alternative Date
Day
*
(Mon-Fri):
Time
*
:
morning (8am - 12 noon)
afternoon (12noon - 5pm)
(Saturday morning appointments are available-
we would request a $20 contribution)
Heating/furnace:
gas
electric
oil
wood
other/don't know
Hot water heating:
gas
electric
oil
wood
other/don't know
Name
*
:
Street Address
*
:
Town
*
:
Main crossroads:
Daytime phone
*
:
Evening Phone:
E-mail address
*
:
Where did you hear
about the COOL Caledon
Electricity Doctor?
newspaper
web site
friend
brochure
other
Questions/
Comments
Please Note:
If this form isn't working, please
email us
.
