Air Con Lead Form

Air Con Lead Form - Branch 7
Todays Date
Sales Person
Customers Name

First NameLast Name
Customer Number
Property Type

Owner OccupiedRental
Tenant Name: First Name Last Name
Tenant Phone: Phone Number
Property Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Phone Number

Area CodePhone Number
Alternative Phone Number

Area CodePhone Number
Email
example@example.com
Discussed Terms of Payment

Cash/EftposCredit CardQ Card Long Term FinanceGem Visa Long Term FinanceHumm
Proposed Unit

High WallCassetteDucted UnitFloor MountMulti-SplitLossnayHot Water Heat Pump SystemOther
Area

LoungeDining / KitchenBedroomHallwayOther
Preferred Assessment Days (Please note this is suggestive only, the team will follow up to confirm assessment day)

MondayTuesdayWednesdayThursdayFriday
Preferred Brand

Mitsubishi ElectricFujitsuPanasonic
Any Additional Information
Option 1
Unit Type
KW Rating
Energy Rating
Remote
Warranty
Total Amount:
Option 2
Unit Type
KW Rating
Energy Rating
Remote
Warranty
Total Amount
Should be Empty:

Air Con Lead Form - Branch 7