Please enable JavaScript in your browser to complete this form.1About You2Your Unit3Your Installer4Your PoolTHANK YOU !!Thank you for purchasing your Heat Siphon Swimming Pool Heat Pump, your business is greatly appreciated. Our Motto – “WE PERFORM TO KEEP YOU WARM!!”SERIAL NO: *FORMAT: 2 digits + 1 CAPITAL LETTER (A-L) + 3 digits. Call us to register older, out of warranty unit.MODEL: *Select Model Numberanalog:CL200HPCL375HPCL575HPdigital:ZL200HPZL375HPZL575HPspecial order analog:C200HP50C200HPXC375HP50C375HPXC575HP3C575HP4C575HP50C575HPXspecial order digital:Z200HP50Z200HPXZ375HP50Z375HPXZ575HP3Z575HP4Z575HP50Z575HPXcooling only:Z575CPZ575CP3Z575CP4Z575CPXMODEL number is found on your NAMEPLATEPOOL OWNER DATAEnter your contact info and a little bit about youPool Owner Email: *NOTICE: Your email address will be kept strictly confidential and will not be released for any reason to anyone outside the company without your specific written approval. We reserve the right to send you HEAT SIPHON information only.Pool Country *220-United States3-Afghanistan6-Albania59-Algeria12-American Samoa1-Andorra9-Angola5-Anguilla10-Antarctica4-Antigua & Barbuda11-Argentina7-Armenia15-Aruba14-Australia13-Austria16-Azerbaijan30-Bahamas23-Bahrain19-Bangladesh18-Barbados34-Belarus20-Belgium35-Belize25-Benin26-Bermuda31-Bhutan28-Bolivia17-Bosnia & Herzegovina33-Botswana32-Bouvet Island29-Brazil101-British Indian Ocean Territory27-Brunei Darussalam22-Bulgaria21-Burkina Faso24-Burundi111-Cambodia45-Cameroon36-Canada50-Cape Verde118-Cayman Islands39-Central African Republic203-Chad44-Chile46-China51-Christmas Island37-Cocos (Keeling) Islands47-Colombia113-Comoros40-Congo43-Cook Islands48-Costa Rica42-Cote D'ivoire (Ivory Coast)94-Croatia (Hrvatska)49-Cuba52-Cyprus53-Czech Republic56-Denmark55-Djibouti57-Dominica58-Dominican Republic212-East Timor60-Ecuador62-Egypt199-El Salvador84-Equatorial Guinea64-Eritrea61-Estonia66-Ethiopia69-Falkland Islands (Malvinas)71-Faroe Islands70-Federated States of Micronesia68-Fiji67-Finland72-France77-French Guiana167-French Polynesia204-French Southern Territories73-Gabon81-Gambia76-Georgia54-Germany78-Ghana79-Gibraltar85-Greece80-Greenland75-Grenada83-Guadeloupe88-Guam87-Guatemala82-Guinea89-Guinea-Bissau90-Guyana95-Haiti92-Heard & McDonald Islands93-Honduras91-Hong Kong96-Hungary104-Iceland100-India97-Indonesia103-Iran102-Iraq98-Ireland99-Israel105-Italy106-Jamaica108-Japan107-Jordan119-Kazakhstan109-Kenya112-Kiribati115-Korea (North)116-Korea (South)117-Kuwait110-Kyrgyzstan120-Laos129-Latvia121-Lebanon126-Lesotho125-Liberia130-Libya123-Liechtenstein127-Lithuania128-Luxembourg140-Macau136-Macedonia134-Madagascar148-Malawi150-Malaysia147-Maldives137-Mali145-Malta135-Marshall Islands142-Martinique143-Mauritania146-Mauritius233-Mayotte149-Mexico133-Moldova132-Monaco139-Mongolia144-Montserrat131-Morocco151-Mozambique138-Myanmar152-Namibia161-Nauru160-Nepal158-Netherlands8-Netherlands Antilles153-New Caledonia163-New Zealand157-Nicaragua154-Niger156-Nigeria162-Niue155-Norfolk Island141-Northern Mariana Islands159-Norway164-Oman170-Pakistan176-Palau165-Panama168-Papua New Guinea177-Paraguay166-Peru169-Philippines173-Pitcairn171-Poland175-Portugal174-Puerto Rico178-Qatar179-Reunion180-Romania181-Russian Federation182-Rwanda86-S.Georgia & S.Sandwich Islands114-Saint Kitts & Nevis122-Saint Lucia231-Samoa194-San Marino198-Sao Tome & Principe183-Saudi Arabia195-Senegal185-Seychelles193-Sierra Leone188-Singapore192-Slovak Republic190-Slovenia184-Solomon Islands196-Somalia235-South Africa65-Spain124-Sri Lanka189-St. Helena172-St. Pierre & Miquelon224-St. Vincent & the Grenadines186-Sudan197-Suriname191-Svalbard & Jan Mayen Islands201-Swaziland187-Sweden41-Switzerland200-Syria216-Taiwan207-Tajikistan217-Tanzania206-Thailand205-Togo208-Tokelau211-Tonga214-Trinidad & Tobago210-Tunisia213-Turkey209-Turkmenistan202-Turks & Caicos Islands215-Tuvalu219-Uganda218-Ukraine2-United Arab Emirates74-United Kingdom220-United States221-Uruguay222-Uzbekistan229-Vanuatu223-Vatican City (Holy See)225-Venezuela228-Viet Nam226-Virgin Islands (British)227-Virgin Islands (U.S.)230-Wallis & Futuna Islands63-Western Sahara232-Yemen234-Yugoslavia38-Zaire236-Zambia237-ZimbabweOwner Type: *Private HomeCondominiumApartmentHotel/MotelResortMobile Home ParkPublic PoolDealer UnitCountry ClubSchoolSpa/Health ClubAquariumOtherGroup Owner Name:If a Club , HOA or other OrganizationFirst Name: *Initial:Last Name: *Occupation: *Approximate Yearly Income Approximately: $ 40K from $25,000 to over $200,000Work Phone: *BirthdayPool Address *Pool City *Pool State (US ONLY) *Select USA StateARAZCACOCTDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNYNVOHOKORPARISCSDTNTXUTVAVTWAWIWVWYUS Pool Locations ONLYPool Zip Code *Please enter your 5 digit USA ZIP CodeFOREIGN COUNTRY Address:Address Line 1Address Line 2CityState / Province / RegionPostal CodePlease SelectAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryContinue to Heat Siphon DataYOUR HEAT SIPHON DATAInstall Date: *Select the date your unit was installedTotal Installed Cost: *Installation Cost of your unit including plumbing and electricPURCHASE INFOPurchase Type *1st Time Pool / Spa Heater OwnerReplacement of Existing HeaterAdding to Existing HeaterPurchase Reason *Brand ReputationService ReputationFriend RecommendedInstaller RecommendedMy Own Research PriceWarrantyCorrosion ResistanceEfficiencyQualityWhat is the MAIN REASON you choose HEAT SIPHON?OTHER REASON:OLD HEATER InformationIf replacing an OLD heater please complete the following:Replacement ReasonsHeater FailureCabinet Rusted OutBad Heat ExchangerHeater AgeEfficiency/ Operating CostLow Heat OutputPoor PerformanceReliabilityOTHER Replacement Reason:OLD Heater TypeSelect OLD heater typeSelect OLD heater typeNatural GasPropane (LP) GasOilElectric ResistanceSolarHeat PumpOLD Heater BrandSelect OLD Heater BrandSelect OLD Heater BrandHeat SiphonCoatesComfortzoneHaywardRaypakRuudSta-RiteTeledyne LaarsFAFCO SolarAerotempAqua CalAquaProAir EnergyCalorexEUSGulfstreamJandyKopecPentairPerigrineRomeSummitSuretempVikingOTHER BRANDName of OTHER BrandOLD Heater ModelBACKContinue to InstallerHeat Siphon InstallerPlease tell us about your installer so we can help future Heat Siphon purchasers in your area. Installer Type: *Pool BuilderPool ServiceHVAC ContractorSolar ContractorPool Supply Co.ElectricianPlumberSelf-InstalledInstalled By: *Company/Individual’s NameInstaller Address Foreign:Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryInstaller Address: *Installer City: *Installer State: *Select USA StateARAZCACOCTDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNYNVOHOKORPARISCSDTNTXUTVAVTWAWIWVWYUS Installer Locations ONLYInstaller Zip Code: *Rate Your InstallerPlease tell us how satisfied you are with your Heat Siphon’s InstallationProduct Knowledge *Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 5Do you feel that your installer has strong technical knowledge on Heat SiphonQuality of Job *Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 5Do you feel that your Heat Siphon was installed correctly and to your satisfactionCost of Installation *Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 5How expensive was your Installer? 1 star = low cost / 5 star= expensiveOverall Satisfaction *Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 51 star = Adequate Job / 5 star= Great JobBACKContinue to Pool DataPOOL DATAPlease tell us about your Pool. Type, size, location etc. CORRECT ANY DEFAULT CHOICES to your pool data:System Type: *PoolSpaComboPools with a Spa = COMBOPool / Spa Type: *ResidentialCommercialPool / Spa Location: *OutdoorIndoorPool / Spa Enclosure: *Open SkyDomedScreened InInside BuildingPool Material: *Vinyl LinerConcreteFiberglassPool / Spa Walls: *IngroundOn GroundAbove GroundOLD Heater: *NoneHeat PumpNat’l GasPropaneSolarElec. Resist.OilSurface Area Units: *SQFTSQMVolume Units *GallonsLitersPool Area (SQ FT): *ENTER Surface Area in SQUARE FEETPool Area (SQ M): *ENTER Surface Area in SQUARE METERSPool Volume (GALLONS): * Enter Pool Volume in GALLONSPool Volume (LITERS): * Enter Pool Volume in LITERSSpa Area (SQ FT): *Enter Surface Area in SQUARE FEETSpa Area (SQ M): *Enter Surface Area in SQUARE METERSSpa Volume (GALLONS): *Enter Volume in GALLONSSpa Volume (LITERS): *Enter Volume in LITERSPOOL/SPA AGE:Pick Age (yrs)New1 yr2 yrs3 yrs4 Vrs5 yrs6 yrs7 yrs8 yrs9 yrs10 yrs15 yrs20 yrsOver 20 vrsPOOL/SPA COST:Select Pool/Spa Cost:Less than $5,000$5,000 to $6,000$6,000 to $7,000$7,000 to $8,000$8,000 to $9,000$9,000 to $10,000$10.000 to $12,000$12,000 to $15,000$15,000 to $17,500$17,500 to $20,000$20,000 to $25,000$25,000 to $30,000$30,000 to $40,000Over $40,000SOURCE: *Heat Siphon OwnerPool BuilderPool ServicemanPool Supply Co.A/C ContractorSolar ContractorFriendPhone BookInternetTVMagazineRadioMailerNewspaperE-mailOtherHow did you learn about Heat Siphon, Who influenced you to pick us.If Other, Please Specify:BACKSubmit