Power Flame Incorporated is committed to continual improvement of our quality in order to meet or exceed our customers' expectations. We value your input and therefore would appreciate receiving your comments regarding the Power Flame equipment you have just purchased.
Installation Company Information
Company Name:
Company Address Line 1:
Company Address Line 2:
State / Prov:
ZIP / Postal Code:
Installer Information
First Name:
Last Name:
Telephone Number:
Email Address:
Burner Information
Serial Number(s):
Burner Model:
Job Order Number: (J followed by 6 digits)
Installation Date:
Job Name (optional):
What is the condition of the burner(s)?

If not excellent, list discrepancies (be specific):
Are all seperately packaged components
in good condition?

If no, list discrepancies (be specific):
Are all components correct?

If no, list incorrect components:

Is there anything you would like changed
or improved? (We cannot guarantee the change):
Other Comments:
May we contact you for additional information
relating to your responses?