Name*

Surname*

Phone number*

Email address*

Area*

Geyser size* Select a geyser size 100 L 150 L 200 L 250 L 300 L

Number of persons* Select number of persons using hot water on a daily basis 1 2 3 4 5 6 7 8 9 10

Roof type* Select a roof type Flat Roof Tilted Roof

Roof Material* Select a roof material IBR Clip Lock Corrugated iron Tiled roof Free standing structure Other

Geyser location* Select a geyser location Outside Inside

Additional information