Contact Information

Name:

Address:

Day Phone Number:

Night Phone Number:

Existing Water Heater Information

Natural Gas:

Electric:

Propane:

Brand:

American W.H. Company A.O.Smith Bradford White Bosch/Aquastar Craftsmaster General Electric Jackson Kenmore Lochinvar Mor-Flo Reliance Rheem Rinnai Richmond State Whirlpool Other

Model Number:

Serial Number:

Size in Gallons:

Height:

Location:

Basement Closet Ceiling 1st Floor 2nd Floor Other

Obstructions:

Additional Comments: