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REQUEST FOR TECHNICAL ASSISTANCE FORM
To assure accurate technical assistance, complete this form entirely. INCOMPLETE FORMS WILL NOT BE PROCESSED Email to TechSupport@wfc-fc.com or FAX (909) 370-0581
CERTIFIED GAS HEATER INSTALLATION/TECHNICIAN INFORMATION
TECHNICIAN'S NAME:
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TECHNICIAN'S NAME:
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Phone Number:
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CERTIFICATION NUMBER
E-MAIL
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E-MAIL
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INSTALLATION LOCATION
Home Owner Name:
Phone Number:
Street Address:
City:
State:
Alabama, AL
Alaska, AK
Arizona, AZ
Arkansas, AR
California, CA
Colorado, CO
Connecticut, CT
Delaware, DE
Florida, FL
Georgia, GA
Hawaii, HI
Idaho, ID
Illinois, IL
Indiana, IN
Iowa, IA
Kansas, KS
Kentucky, KY
Louisiana, LA
Maine, ME
Maryland, MD
Massachusetts, MA
Michigan, MI
Minnesota, MN
Mississippi, MS
Missouri, MO
Montana, MT
Nebraska, NE
Nevada, NV
New Hampshire, NH
New Jersey, NJ
New Mexico, NM
New York, NY
North Carolina, NC
North Dakota, ND
Ohio, OH
Oklahoma, OK
Oregon, OR
Pennsylvania, PA
Rhode Island, RI
South Carolina, SC
South Dakota, SD
Tennessee, TN
Texas, TX
Utah, UT
Vermont, VT
Virginia, VA
Washington, WA
West Virginia, WV
Wisconsin, WI
Wyoming, WY
Zip:
PURCHASED FROM
INSTALLED BY
PROBLEM
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MODEL NO
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SERIAL NUMBER
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DATE INSTALLED
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UPLOAD PICTURES AND FILES
INSTALLATION DATA
Unit Location: (Additional information may be required for areas not completed in this section)
TYPE OF BUILDING
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Office
Home
Barn
School
Hotel/Motel
Other
TYPE OF ROOM
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Basement
Bathroom
Bedroom
Den
Family Room
Garage
Kitchen
Living Room
SIZE SQ. FT: (L*W*H)
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NEW INSTALLATION
Yes
No
Don't Know
GAS LINE PURGED
Yes
No
Don't Know
LEAK TEST ALL FITTINGS
Yes
No
Don't Know
MANIFOLD PRESSURE IN W.C.
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GAS LINE PRESSURE IN W.C.
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DEDICATED CIRCUIT
Yes
No
Don't Know
PILOT/THERMOCOUPLE MILIVOLT READING
PILOT ONLY
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PILOT & BURNER
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VOLTAGE
120V
240V
ALTITUDE
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0-2,000'
2,001-4,000'
4,001-6,000'
6,001-8,000'
LENGTH OF THERMOSTAT WIRE
DERATED
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Yes
No
Don't Know
GAS TYPE
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Natural Gas
Propane
APPLIANCE REGULATOR ON LINE
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Yes
No
VENTING DATA - TOP-VENT
NEW VENTING
Yes
No
EXISTING VENTING
Yes
No
VENT SIZE
3"
4"
5"
VENT MATERIAL USED
Type B
Type B/W
Other
IF OTHER, WHAT KIND
LENGTH OF VENTING TO ROOF LINE
LENGTH OF VENTING ABOVE ROOF LINE
NUMBER OF 90 DEGREE VENTING ELBOWS USED
NUMBER OF 45 DEGREE VENTING ELBOWS USED
COMMON VENTING W/ OTHER APPLIANCE
Yes
No
VENTED INTO CHIMNEY
Yes
No
WILLIAMS VENT ACCESSORIES USED
9901
9902
None
Other
WILLIAMS VENT ACCESSORIES USED
9901
9902
None
Other
VENTING LENGTH PRIOR TO FIRST OFFSET
COMMON KIT USED
DISTANCE FROM HEADER PLATE TO BOTTOM PLATE
VENTING DATA - DIRECT-VENT
RECESSED MOUNTED
Yes
No
SURFACE MOUNTED
Yes
No
WALL THICKNESS
TYPE OF TUBING
VENT TUBING
Cut
Overlapped
Crimped
WILLIAMS ACCESSORIES USED
4318
9307
None
Other
VENT ACCESSORIES USED
Vent Extension Kit
Other
None
SERVICE
DESCRIBE ANY SERVICE PERFORMED
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LIST ANY PARTS THAT HAVE BEEN REPLACED • WILLIAMS OEM/OTHERS
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COMMENTS
SERVICED BY
DATE
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PHONE NUMBER
E-MAIL