Mendota Process Form
Notes Mendota Gas Fireplace
Customer Information
Team Member Name:
Please Select
Annie Harrison
Kilty Ellis
Christine McPhetridge
Mike Atherton
Bert Whitle
Install Service Team
Customer Name
First Name
Last Name
Customer Email
example@example.com
Address of the Mendota Installation
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Design Choices
This section outlines the steps we go though to pick out the stove
Please select the following situation that best describes what you have currently?
Open fireplace that I want to insert something into
Blank wall
There is a an existing fireplace that I want to tear out & update
We want the stove to be freestanding stove (not a Mendota)
Back
Next
Do you have pictures of the fireplace as it currently is including exterior pictures showing the venting options?
Yes
No
If you look at the outside of your chimney is it wrapped in wood or brick? (If brick or stove it could be a masonry chimney, if wood framed with siding than its likely class A though the roof.
Masonry
Steel chimney
Is your fireplace opening flat against the ground/hearth or is there a gap between the hearth and the opening? (This might help us know if they have zero clearance fireplace, but it also tells us if they need a 4 sided surround or not if an insert)
Flat against the ground/hearth
A gap between the hearth & the opening
What is the stone/tile material around your fireplace opening? Trying to determine the fit and finish of the surround is correct.
For inserts, will the surround be able to fit flat against the stone/tile face?
How will the unit be vented? include any dimensions to those locations.
Select the situation that best describes how your unit will be vented through your home? (single or double story vent kit)
Up and out venting (for fireplaces only)
Single story : 12-20 feet vertical
Double story: 21- 30 feet vertical
Other
Back
Next
Does your fireplace burn wood or gas currently?
Do you have pictures and dimensions?
Yes
No
What is the height of the ceiling?
Explain the location of the fireplace on the wall?
Is there anything going above the fireplace like mantel or tv?
Yes
No
If you are looking for a mantel are you interested in seeing the options Axmen has for mantels (magrahearth)
Yes
No
Is there a shape of fireplace that you are interested in?
What is your main goal in having this fireplace?
Heat
Looks
Both
Would you like the fireplace to compliment the stone around it and your flooring?
Yes
No
Indifferent
Back
Next
Does your house already have gas?
Yes
No
Is it natural gas or propane?
Natural Gas
Propane
How far away is the gas line from where we are putting the appliance?
Back
Next
Please add notes to issues that need special attention and issues not covered in the form so far:
Have we discussed the lead times, processes, deposit to get started, & final payment from sale to install for Mendota?
Yes
No
By Signing this form you are acknowledging that the information you have given us is accurate to the best of your knowledge.
Clear
Submit
Should be Empty:
Now create your own Jotform - It's free!
Create your own Jotform