Furnace Rental Online Application Form

Bosanac Heating & Electric offers Furnace Rental for its customers at the convenience of low monthly payments.

RENTAL benefits:

Low, affordable monthly rates
No up-front equipment costs
No repair bills – just worry-free home comfort
Free equipment replacement during contract term – should your equipment be un-repairable as a result of normal use
Service provided by responsive, local service providers
Rate Increase Protection – Your Vista contract will not be subject to arbitrary, unexpected, and excessive rate increases. The contract includes a rate increase guarantee.
The convenience of payment on your local gas utility bill (where available) or by pre-authorized payment

Required fields are marked with *

Name*
First Last
DATE OF BIRTH*
MM slash DD slash YYYY
STREET #*
STREET NAME*
UNIT
CITY / TOWN*
POSTAL CODE*
PHONE*
PHONE (alt.)
E-MAIL*
*
- I AM THE HOMEOWNER
- I AM A TENANT
- RENTAL PROPERTY THAT I OWN
NEW EQUIPMENT
NEW EQUIPMENT TYPE(S) +*
+ Use CTRL key to select more than one equipment type.
OLD EQUIPMENT
CURRENT RENTAL PROVIDER
OLD EQUIPMENT TYPE(S) +*
+ Use CTRL key to select more than one equipment type.
OLD RENTAL RATE $
Date
MM slash DD slash YYYY
Untitled
IS THIS A COMMERCIAL APPLICATION?*
- Yes
- No
(i.e. restaurant, office, retail store...)
DID YOU SIGN AN AGREEMENT WITH YOUR OLD RENTAL EQUIPMENT PROVIDER?*
- Yes
- No
COMMENTS and NOTES
*
- You authorize Bosanac Heating & Electric to make any inquiries concerning your credit and you authorize any consumer reporting agency, or any other company with whom you have financial relations to furnish credit information to Bosanac Heating & Electric.

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