Brand Name:  
Model #:  
Serial #:  
Name:  
Address:  
City:  
State:  
Zip Code:  
Date Purchased:  
Phone Number:  

Retailer where fireplace/gas log was purchased:
Name:  
City:  
State:  


Where will the fireplace/gas log be used?
Living/ Family Room
Dining Room
Office/Study
Basement
Other:
  Please Specify


Who selected the fireplace?
Male
Female
Both

What is the population of your area?
Under 50,000
50,000-100,000
100,000-250,000
Over 250,000


What is your primary source of heat?
Natural Gas
Propane (LP Gas)
Fuel Oil
Electric
Wood
Other:
  Please Specify


How was the fireplace/gas log installed?
Professional Installer
Self
Other:
  Please Specify

Cost of fireplace/gas log: $
Cost to install: $


What type of home will the fireplace/gas log be installed?
Condominium
Apartment
Town Home
Mobile Home
Single Family Home
Other:
  Please Specify


With your fireplace/gas log, did you purchase any accessories? (Check all that apply.)
Blower
Remote Control
Cabinet Mantel



How did you learn about this product?
Advertising
Relative or friend
Store Display
Other:
  Please Specify


Age of purchaser:
Under 20 yrs.
20-29 yrs.
30-39 yrs.
40-49 yrs.
50-59 yrs.
60 or over


Type of store where fireplace/gas log was purchased:
Hearth Products Retailer
Propane Retailer
Natural Gas Utility
Home Center/ Builder's Supply
Hardware Retailer
Farm Store
Other:
  Please Specify


What motivated you to buy the fireplace/gas log? (Check all that apply.)
Replace older product
Hard to heat location in home
Emergency back up heat
Fireplace/gas log was on sale
Energy savings/ high efficiency
Decorative addition to the room
Eliminate wood burning
Heat output
Other:
  Please Specify


Buyer's total annual household income is:
Less than $49,999
$49,999 to $99,999
$100,000 and over

In choosing your fireplace/gas logs:

Price was:  

Brand name was:  

Overall quality was:  

Heat output was:  

Log appearance was:  

Warranty was:  

Local service was:  

Ease of installation was:  

Heating Efficiency was:  

Remote control operation was:  

 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               






 




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