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Salutation :
First Name* :  
Last Name* :  
Street Address* :  
  :
   
City* :  
State/Province* :  
Zip/Postal Code* :    
Country* :  
Phone* : Numeric Only 
Age :
E-mail Address* :  
  :
Please Tell Us About Your Fireplace    
Where did you purchase your fireplace? :    
Product Category :
Mantel Model Purchased * :  
What is the finish/color of your mantel?* :
Fireplace Insert Model Purchased * :  
Purchase Date* :   
Serial Number (located on the back
sticker of the fireplace insert) *
:  
What type of Residence will this fireplace be used in ? :
Do you own or rent your residence? :
Select the main use of your fireplace?* :
What room will you be using your fireplace in? :  
How many hours do you plan on running the heater? :
What two reasons did you base your purchase of this fireplace on* :    
How would you rate the ease of assembly? :
Were the instructions easy to follow and clear? :
Does the wood mantel meet your expectations? :
Does the fireplace insert meet your expectations? :
Please describe your family income :
Would you buy another product from our company? :
Comments :