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Name and Surname:
Telephone number:
Email Address:
Physical Address:
Nearest Dealer:
...
Amanzimtoti
Bela Bela
Bethlehem
Bloemfontein
Botswana
Cape Town
Durban
East London
East Rand
Empangeni
George
Grahamstown
Johannesburg Central
Johannesburg North
Johannesburg South
Kimberley
Knysna
Krugersdorp
Ladysmith
Mafikeng
Mosselbay
Namibia
Orania
Parys
Pietermaritzburg
Port Elizabeth
Potchefstroom
Pretoria
Richards Bay
Rustenburg
Secunda
Tzaneen
Upington
White River
Witbank
Kind of building:
<Please select>
House
Cottage
Office
Other
How many people are in your household?:
<Please select>
1
2
3
4
5
6
7
8
9
10
What kind of roof do you have?:
<Please select>
Flat
Shallow pitch
Steep pitch
Thatch
Province:
Eastern Cape
Free State
Gauteng
Kwa-Zulu Natal
Limpopo Province
Mpumalanga
North West
Northern Cape
Southern Cape
Western Cape
Country:
South Africa
Namibia
Swaziland
Lesotho
Orientation of the roof:
<Please select>
North
East
South
West
Number of storeys:
<please select>
1
2
3
4
Number of bathrooms in the building:
<Please select>
1
2
3
4
5
6
7
8
9
10
Number of electrical geysers in the building:
<Please select>
1
2
3
4
5
6
7
8
9
10
How much is your monthly electricity bill?:
<Please select>
0 - 400
400 - 800
800 - 1200
More than 1200
Will you apply for the Eskom incentive?:
Yes
No
Would you like to match your solar geyser colour to that of your roof?:
Yes
No
Would you like to subscribe to the newsletter?:
Yes
No
Why are you interested in a solar water heater?:
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Tel: +27 861-SOLAHART (76524278) - Fax: +27 (11) 705 2614 - Email: info@solahart.co.za
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