Registration | GreenHome Network

Full Name*

Phone*

Email*

Address*

Street Address City ZIP / Postal Code

Reference#*

Notes*

Signature*

YES

Signature

Home Assessment – Check All that Apply

I’ve had a flood in my home before.

I do not have a flood protection.

I do not have any water filtration systems.

My insulation is over 15 years old.

My windows & doors are over 15 years old.

My furnace is over 8 years old.

My air conditioner is over 8 years old.

My water heater is over 8 years old.

I have air quality issues.

My bills are too high.

Is your current water heater storage or tankless?

Storage

Tankless

HVAC Appointment*

Choose Timing Slots*

1:00pm to 3:00pm

3:00pm to 5:00pm

5:00pm to 8:00pm

11am to 1pm (Only Saturdays)

Checkbox to be contacted to schedule appointment.

Solar

Windows/Doors

Confirmation*

I confirm that I am the homeowner for the address above.

Confirmation*

I confirm that I have read, understood and agree to the Canadian GreenHome Network terms and conditions.

Confirmation*

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”), Energy Experts, Brawn Bros Heating and Cooling Solutions Ltd., and/or its Ontario network partners (collectively, “Partners”) about their programs including air sealing, insulation, windows/doors, water filtration, solar power products, 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.

Appointment

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