Lehigh Valley Burkholder's Heating Ventilation & Air Conditioning Creating comfortable environments.

Please fill in the information below to provide information to schedule a service appointment with us. Your request will be sent to one of our representatives and we will contact you to schedule an appointment that is convenient for you. Thank you.

*Required fields.

*Name:     

*Email:      

*Address:  

*City:        

*State:      

*Zip:         

Daytime Phone:    

Evening Phone:     

Are you currently a Burkholder's-HVAC service agreement customer?
Yes No

Would you like to renew your Burkholder's-HVAC contract?
Yes No

What type of service would you like us to do for you?
Please select all that apply.
Repair (non-emergency)
'Get What you Paid For" in the mail Maintenance Visit
Service Agreement and would like to schedule my cleaning
$65 10 Point Inspection

Please select Type of Fuel below.
Oil
Gas
Heat Pump/Electric

Please describe your request in the box below:

If you were referred to us please let us know their name

Type of Equipment:
Choose one from below: A/C only Heat pump Geo-thermal heat pump Gas warm-air furnace Gas hot-water boiler Oil warm-air furnace Oil hot-water boiler Oil hot-water heater Gas Hot water heater Electronic hot water heater Humidifier OFF peak storage unit Rooftop unit Ductless wall split unit Other

Make of Equipment:
Choose one from below: Amana American Standard Carrier York Rheem Lennox Trane Rhuud General Electric Sanyo Mitsubishi Goodman Energy Kinetics Burnham Daikin LG Weil-McLain Burnham Energy Kinetics System 2000 Florida Heat Pump ClimateMaster WaterFurnace Aprilaire Other

What time of day would you prefer for your appointment?
8 am - 10 am
10 am - 12 pm
12 pm - 2 pm
2 pm - 4 pm
4 pm - 6 pm

What type of payment will you be using?
Cash
Check
Visa
Mastercard
Discover

How would you like our service representative to contact you?
Email Phone

How did you hear about us?
Internet Search Engine Angie List Existing Customer Burkholder Employee Magazine Ad TV ad Direct Mail Radio Ad Print Ad Home Show Phone Book Saw your Trucks Internet Search Word of Mouth other

Questions, Comments or Special Requests:

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