Business Name / Building Name
*
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What is the use of this room?
*
Classroom
Office
Meeting Room
Lobby
Restaurant
Retail
Other
Primary Customers
*
Adults
Teenagers
Pre-Teens
Classroom Age Range
5 - 8 Years Old
9+ Years Old
Adult
Are we able to install a Cellular Router to supply WiFi to our Air Quality Monitors?
Yes
No
What is the approximate year that the building was constructed?
What is the maximum occupancy of this building?
What months are the doors left open?
*
Summer Months
Fall Months
Winter Months
Spring Months
Would you be interested in a possible grant?
Yes
No
What are your business hours?
Hour Minutes
AM
PM
AM/PM Option
What would you say would be your peak hours?
Hour Minutes
AM
PM
AM/PM Option
Optional
These selections, if known will speed up our assessment process.
Select the Features of Your Existing HVAC System (If Known)
MERV 8 Filtration
MERV 13 Filtration
HEPA Filtration
UV-C Lighting
Humidity Control
Outside Air Intake
Total Flow Rate
Existing Air Purifier
Other
Outside Air Flow Rate (CFM)
*
Total Flow Rate (CFM)
*
Air Purifier (CFM)
*
Other things we should know?
Please verify that you are human
*
Submit
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