Gas Online Appointment Form

 no yes
 AM PM
  1. Have we been to this house before?  Yes No
  2. Type of house:  Rambler Split 2-Story Other
  1. Gas Appliance Type  Insert Gas Log Set (masonry/pre-fab)
  2. Make Model
  3. Do you have the owner's manual?  Yes No
  4. Have you noticed any smells?  Yes No

  1. Is there any soot or staining on the glass?  Yes No
  2. How long have you owned the appliance?
  3. When was the last time you used it?
  4. What are the problems with the appliance?
  5. Have you had anyone else look at it?  Yes No
  6. What color is the flame?  Blue Yellow Yellow & Black Other

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