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540 NORTHFIELD ROAD - P.O. BOX 434
BERNARDSTON, MA - 01337
1-800-327-9992 or 413-648-9912
Country Oil Solar Site Survey
Name*
 Date
Address
 City
State
 Zip Code
Phone number
 Cell Phone
Email Address*
Request for:  
 Domestic Hot Water
 Space Heating
 Pool/Spa Heating
Commercial Hot Water
 Other
Roof Construction:
 Asphalt
 Metal  
 Tar and Gravel
Rubber
 Other
Installation Area:
 Flat Roof
 Ground Mount
 Wall Mount
Sloped Roof
Shading:  
 None
 Partial
 Large Trees/Buildings
Age of Home:  
Domestic Hot Water Load:  
 Number of people in the home?  
Number of bathrooms?
Multi-Family:  Number of Apartments
Existing Heating System:  
 Hot Water
 Warm Air
 Steam
Electric
 Hydro Air
 Other:  
Heat Distribution:  
 Radiant Floor
 Baseboard
 Radiators
Forced Air
 Other
Existing Hot Water:
 Oil
 Gas
 Electric
 Indirect  
Pool Heating:  
 Dimensions (length/width)
Average Depth
 Pool Cover?
Desired Temperature
 Hours Covered
Gallons (if known)
 Solar Cover Usage (Hours)
Additional Questions or Comments: