CUSTOM DESIGN

HEATING & AIR CONDITIONING

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(631) 567-0944

Find Us

91-C Knickerbocker Ave
Bohemia, NY 11716

Schedule Request Form

In order to better schedule your request, all fields marked with a * are required.

Contact Info:
Are you an existing customer? yes no
*First Name
* Last Name
* Street Address
* City
* State/Province
* Postal Code
* Email address
* Confirm email address
* Phone Number
  
Appointment Type Requested
I am requesting an appointment for

Best time to contact you?

Appointment Availability
Indicate as many days and times as possible that you would be available to have us visit your home. We will call to confirm the time scheduled.
When
Morning Noon Afternoon Evening
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday (if possible)

Please provide the following information to help us better understand and evaluate your needs:
My primary heating system is a...
I use a second heating system which is a..
My primary heating fuel is...
I cool my home with a
I estimate the age of my heating system to be...(Guess if you don't know)
I estimate the age of my cooling system is...(Guess if you don't know)

Nature of problem or additional comments:
Click on "Submit" to send us your request and we will respond as soon as possible.