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1)Which description(s) below best describe your project? ( Check all that apply. )
 Retrofit and/or convert an existing fireplace Replace an existing Hearth Appliance Accessorize, enhance, or change the appearance of an existing Hearth Appliance Add a new Hearth Product - existing living space Add a new Hearth Product - new construction (either new house or new addition on existing house)

2.)In order of preference what are your desired goals benefits of this Hearth Solution project?

Heating Goals and/or Benefits:

Convenience Goals and/or Benefits:

Ambiance and Design Goals and/or Benefits:

Fuel Utilization Goals and/or Benefits:

3.) Is there a particular type of hearth product that you are thinking about purchasing? (Check all that apply.)

 Gas Fireplace Wood Fireplace Electric Fireplace Gas Stove Wood Stove Electric Stove Gas Insert Bio-ethanol Fireplaces Outdoor Kitchens BBQ’S Glass Doors Stone Facings (marble, granite, stone)  Mantel Pellet Stove Pellet Insert Gas Logs Electric Insert Wood Insert
Other/Accessories:

4)Please indicate your level of interest by checking an option below:

5.) Please enter any other questions, comments, or information you wish for us to address:

6.)How would you like us to contact you?

7.) Contact information gathering fields needed: (* indicates required)

*First Name:
*Last Name:
Company Name:
*Home Phone:
Mobile/Work Phone:
*Email Address:
*Address:
*Address:
Apt/Unit
*City:
*State:
*Zip:

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