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Your Name: * (Required)
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Address:
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City:
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State:
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Zip:
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Home Phone:
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Business Phone:
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Email:* (Required)
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Number of Heating Systems?
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Gas:
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Oil:
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Heat Pump:
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Do you have a well pump?:
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Do you have septic pumps?:
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Do you have a sump pump?:
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Number of people living in the home including children?:
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In an outage, for how long would you need backup power?:
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Do you have a home office?:
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Do you have a media room?:
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Which of the following items would you like to have on a back up system?:
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What is the best time to contact you?:
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Would you like to receive a brochure?:
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How did you hear about Banner Power Company?:
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Privacy Notice:
The information obtained in this survey is considered confidential and will not be sold or transferred.
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