Name/Address:
Home Number:
Business Number:
Email:*
Type of Fuel for Heat:
Number of Heating Systems
Do you have a well pump?
Please Select
Yes
No
Voltage
120 Volts
240 Volts
Don't Know
Do you have a sump pump?
Please Select
Yes
No
Number of people living in the home including children?
In an outage, for how long would you need backup power?
Please Select
3-5 hours
10-15 hours
24 hours
48 hours
Do you have a home office?
Please Select
Yes
No
Do you have a media room?
Please Select
Yes
No
Any questions/comments?
Privacy Notice:
The information obtained in this survey is considered confidential and will not be sold or transferred.
iPower Systems LTD, Inc.
115 Wall Street
Suite B
Valhalla, NY 10595
Toll Free:
800.618.9774
Phone :
914.449.2003
Fax :
734.592.2739
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