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Questions	Your Answers
Name
Surname
Street Address
Suburb
Province	Gauteng Eastern Cape Free State KwaZulu Natal Limpopo Mpumalanga North West Northern Cape Western Cape
Home Telephone
Work Telephone
Fax
Cellphone
Email
Roof Type	Slate Thatch Tile IBR Sink Brown Built Other
If other, please specify
Pitch (Generally 25-28 degrees)
Flat Roof	Yes No
North Facing	Yes No
Stories / Levels	Single Double Triple
Roof Truss Spacing	600-700mm 700-800mm 800-900mm 900-1000m 1000mm+
Number of Geysers	1 2 3 4+
Geyser 1 Size	Litres
Geyser 2 Size	Litres
Geyser 3 Size	Litres
Geyser 4 Size	Litres
Direct Sun On Roof	Always Mostly Sometimes Hardly Ever
Distribution board space for timer switch (5cm x 6cm)	Yes No
Electricity on site for powertools	Yes No
New / Existing House	New House Existing House Renovating House
Type of water pipes	Galvanised Copper Poly-cop Pex Other
Daily number of household occupants
Number of people per age group
0-4 years
4-11 years
11-21 years
21+ years
Water consumption pattern - mostly	Shower Bath Mixed
Current electricity consumption	KwH
How would you like to be contacted	Telephone Fax Email
Additional comments or information
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