Name 
           Title 
         Company 
  Street address 
                 
            City 
  State/Province 
 Zip/Postal code 
         Country 
           Phone 
             Fax 
          E-mail 

1). Size of the area you are heating?
	
	type of area you are heating?
	
	Number of outside walls 
	Any windows? Yes No
	Window placement and sizes?
	
2). Coldest temperatures in the state you are living in or outside area?
	
3). Type of optional control required? (On/Off, ambient thermostat, etc.)
	
4). Where would you like to mount the heaters?
	
5). Is the surrounding area considered a hazardous location?  Yes No
    	Location classification?  Class  Division
6). What power is available for the heating system? (Options include:
	Plug-in or direct wired type, 120Volt, 240V, 480V heaters, etc.)
	 voltage,  phase,
	 amperage.
7). Type of insulation (thickness) in the floor, walls and ceiling?