Schedule Service       In order to better schedule your request, all fields marked with a *are required. Contact Info : Are you an existing customer? yes no *First Name * Last Name * Street Address * City * State/Province * Postal Code * Email address * Confirm email address * Phone Number   Appointment Type Requested : I am requesting an appointment for Select One Service New / Replacement Equipment Annual Maintenance   Appointment Availability : Indicate as many days and times as possible that you would be available to have us visit your home. We will call to confirm the time scheduled. When Select One As soon as possible This week Next week In two weeks No hurry Morning Noon Afternoon Evening Monday Tuesday Wednesday Thursday Friday Saturday (if possible)   Please provide the following information to help us better understand and evaluate your needs : My primary heating system is a... Select One Not Applicable Forced Air Furnace Heat Pump Ground Water Heat Pump Hot Water Boiler Steam Boiler I use a second heating system which is a.. Select One Not Applicable Forced Air Furnace Heat Pump Ground Water Heat Pump Hot Water Boiler Steam Boiler My primary heating fuel is... Select One Natural Gas Propane (L.P.) Gas Electricity Fuel Oil Other I cool my home with a Select One Not Applicable Central Air Conditioning Window Air Conditioners Heat Pump I estimate the age of my heating system to be...(Guess if you don't know) Select One 1-5 years old 6-10 years old 11-15 years old 16-20 years old over 21 years old I estimate the age of my cooling system is...(Guess if you don't know) Select One 1-5 years old 6-10 years old 11-15 years old 16-20 years old over 21 years old   Nature of problem or additional comments : How did you hear of us? Select One Previous Customer TV Advertisement Yellow Pages Radio Advertisement Sign on Service Truck Telemarketing Billboard Click on "Submit" to send us your request and we will respond as soon as possible.

Contact Info:
Are you an existing customer?	$exist
First Name	$name
Last Name	$lname
Street Address	$addr
City	$city
State/Province	$state
Postal Code	$postal
Email address	$email
Phone Number	$phone

 

Appointment Type Requested
I am requesting an appointment for	$servicetype

 

Appointment Availability
Indicate as many days and times as possible that you would be available to have us visit your home. We will call to confirm the time scheduled.
When	$timeframe
	Morning	Noon	Afternoon	Evening
Monday	$monmor	$monnon	$monaft	$moneve
Tuesday	$tuemor	$tuenon	$tueaft	$tueeve
Wednesday	$wedmor	$wednon	$wedaft	$wedeve
Thursday	$thumor	$thunon	$thuaft	$thueve
Friday	$frimor	$frinon	$friaft	$frieve
Saturday (if possible)	$satmor	$satnon	$sataft	$sateve

 

Please provide the following information to help us better understand and evaluate your needs:
My primary heating system is a...	$pheat
I use a second heating system which is a..	$sheat
My primary heating fuel is...	$pfuel
I cool my home with a	$pcool
I estimate the age of my heating system to be...(Guess if you don't know)	$htage
I estimate the age of my cooling system is...(Guess if you don't know)	$clage

 

Nature of problem or additional comments:

$comments

How did you hear of us? $mrkt_opt

  "; //echo $message; $to = $row['toemail']; $toguz = "[email protected]"; $tomis = "[email protected]"; $torom = "[email protected]"; $towood = "[email protected]"; //$to = "[email protected]"; $subject = "New Contact Inquiry"; $body = $message ; $from = $_POST['email']; Ini_set('sendmail_from', $from); $mail_sent = mail($to, $subject, $body, "From:$from\r\nReply-to: $strFrom\r\nContent-type: text/html; charset=us-ascii"); $mail_sentguz = mail($toguz, $subject, $body, "From:$from\r\nReply-to: $strFrom\r\nContent-type: text/html; charset=us-ascii"); $mail_sentmis = mail($tomis, $subject, $body, "From:$from\r\nReply-to: $strFrom\r\nContent-type: text/html; charset=us-ascii"); $mail_sentrom = mail($torom, $subject, $body, "From:$from\r\nReply-to: $strFrom\r\nContent-type: text/html; charset=us-ascii"); $mail_sentwood = mail($towood, $subject, $body, "From:$from\r\nReply-to: $strFrom\r\nContent-type: text/html; charset=us-ascii"); if($mail_sent) { echo "success"; } else { echo "failure"; } if($mail_sentguz) { echo "success"; } else { echo "failure"; } if($mail_sentmis) { echo "success"; } else { echo "failure"; } if($mail_sentrom) { echo "success"; } else { echo "failure"; } if($mail_sentwood) { echo "success"; } else { echo "failure"; } ?>