Genius Energy Lab
Order Form
Company Name
*
Name of company placing the instruction
Project Lead Name
*
First Name
Surname
Project lead email
*
example@example.com
Project Details
Project Name
*
Address
*
Street Address
Street Address Line 2
Town
County
Post Code
Service Required
*
Initial Geology
GSHP Design
Pre Feasibility
Enhanced Pre Feasibility
Feasibility Study
Other
Please specify preferred loop type
*
Horizontal
Vertical Boreholes
Open Loop
Pond Loop
Preferred Architecture?
Slinkies
2 Pipe
6 Pipe
Please state required service
*
Preferred Max Drilling Depth?
Preferred Max Trench Length?
Please upload site plan below
Heat Pump Make and Model
Requested Delivery Date
*
-
Day
-
Month
Year
Minimum Timescales, Initial Geology 5 working days. GSHP Design 10 working days.
Notes
File Upload
Browse Files
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This can be used for diagrams, maps, photos or any other information.
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Loads
Peak Heat Loss (kW)
*
Annual Heating Load (kWh)
Heat Full Load Hours (if Annual Heating load is unavailable)
*
Heating Flow Temperature Required
Do you have a separate value for the Domestic Hot Water
No - it is included in the value given above
Yes
Annual Domestic Hot Water Load (kWh)
Do you require Cooling?
No
Yes
Peak Cooling Load (kW)
*
If cooling is required
Annual Cooling Load (kWh)
If cooling is required
Cooling Full Load Hours - if Annual Cooling load is unavailable
Cooling Flow Temperature Required
Please indicate the main driver for this project
Maximum Efficiency
Balanced
Minimum Install Cost
File Upload
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This can be used for load files
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I have included all Load information & acknowledge that work will not commence on the project until this is received.
*
Yes
No
Reason for not submitting loads?
Accounts
Your Account Manager
Duncan Rae
Ami Baker
New Customer?
No
Yes
Accounts Payable name
*
Accounts Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Accounts Payable Telephone number
*
-
Accounts Payable email
*
example@example.com
Genius Energy Lab Proposal Number
If you have received a proposal number please enter it here.
Quotation £
Excluding VAT
Purchase Order Number
*
This is required
Purchase Order
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Terms, Condition and Submission
Has a contract been signed?
Please Select
No
Yes
Signature for Instruction
*
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