LEAD Questionnaire Grainger Tremco

GRAINGER SALES REP INFORMATION

Form submitted by: (Name)*

Form submitted by: Email*

Form submitted by: Phone Number*

In order to help you best please answer the questions pertaining to your prospect’s building(s). The answers you provide will assist in determining the best course of action.

PROSPECTIVE CUSTOMER INFORMATION

Is this a Coronavirus Inquiry?*

yes
No

Coronavirus Inquiry (select one)*

Proactive
Reactive (someone in facility had or was exposed to the virus)

Company Name*

Contact*

Position*

Address*

City/ State*

ZIP Code*

Phone

Cell*

FAX

Email*

Website

Project Location

Company Name*

Address*

City*

State*

ZIP Code*

Contact

Building Attributes:

Building Age in Years*

Number of Floors*

Square Footage (Approx.)*

HVAC Equipment Type

Choose all that apply.

Ductwork Type

Choose all that apply.

General Building Use*

Air Handler Type?

Number of Air Handler Units?

File Upload

Please include floor plans, mechanical inventory, site photos and spreadsheet if multiple locations. File types accepted: .jpg, .pdf, and .xls. No more than 5MB each. Maximum 10 files.

Drop files here or

Accepted file types: pdf, jpg, xls, Max. file size: 5 MB, Max. files: 10.

Timeframe when services are needed?*

Requested Scope of Work*

Choose all that apply.

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Name

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