Contractor Company:

 Contractor Phone:

Your E-Mail:

Builder or Homeowner Name:

Builder or Owner Phone:

Project Address:

City :

Zip:

New Construction or Alteration?

New Construction 
HVAC Alteration / Change-Out 
Other 

Check All That's Being Replaced or Installed

Furnace / Air Handler 
Coil 
Heat Exchanger 
Outdoor Unit / Condenser 
Package Unit 
40 feet + ductwork 

Job Type:

Residential
Commercial
Other 

Permit Number:

Part of Sample or 100% Testing:

Sample 
100% Testing 

Preliminary Tests (CF-6R) performed by:

Contractor / Builder 
So Cal HERS Raters 

Job Calls For:
(check all that apply)

Tight Duct Test 
TXV Verification 
Home Infiltration 
EER Verification 
Adequate Airflow 
Quality Insulation Installation 
Other

Estimated Date For HERS Verification:

Additional Information: