Name:

Address:

Contact No:

Email:

Integrated Unit

Integrated Volume Size :

Split Retro-fitted Type Unit

Geyser Size to be retro-fitted to:

Type and Size of Heat Pump Required (Please tick) :

Quote to replace my geyser included with a Heat Pump

The Dwelling where the heat pump is to be installed, is a

(Quote will be forwarded  to this email address)

(Address where installation is to take place)

I wish to claim the ESKOM rebate and understand ESKOM’s

Terms and Conditions