Product Selection

Customer Info

Full Name *

Phone *

Email Address *

Street Address *

City *

ZIP / Postal Code *

Schedule Appointment Date

Month

Day

Year

Schedule Appointment Time

Hours

Minutes

AMPM

Schedule Appointment Time

Products

96 AFUE Furnace: $89.95Cash Rebate: $400

Air Conditioner: $74.95Cash Rebate: $200

Tankless 160BTU: $49.95Tankless 180BTU: $54.95Tankless 199BTU: $59.95Cash Rebate: $250

Gas WH 40 GAL: $23.50Gas WH 50 GAL: $25.25Gas WH 60 GAL: $27.50

HEPA + UV Air Filter: $39.95

Combos

96 Furnace/AC COMBO: $144.95COMBO Cash Rebate: $600

96 Furnace/AC/Tankless 160BTU COMBO: $189.95COMBO Cash Rebate: $800

Add on: Ecobee Smart ThermostatAdd on: Google Home MiniAdd on: Google Nest Hub

Other Combo:

Reference # *

No Signature

By completing this request I hereby consent to the collection and use of such information only for the purposes of being contacted by Canadian GreenHome Network (“GHN”), Brawn Bros Heating and Cooling Solutions Ltd., and/or its network partners (collectively, “Partners”) about their programs including air sealing, insulation, windows/doors, water filtration, and heating and cooling solutions such as furnace, air conditioning, heat pumps, and water heating products and services (collectively, “Goods and Services”). I hereby consent to, and request that, GHN and its Partners contact me to discuss their products and solutions, and to schedule a time for a Partner representative to attend my dwelling for the express purpose of entering into an agreement and/or to discuss purchase options for one or more Goods and Services. I acknowledge and agree that I have no obligation whatsoever to enter into an agreement with any Partners.