Chim-Scan Order Form

I'm looking for pricing on a standard Chim-Scan® unit (did you look at the bottom of the units page)I'm looking for pricing on a Chim-Scan® with a couple of add-ons.I was getting pricing for my boss and wasn't sure where to look.I have some questions but would like to get pricing. (Look at the bottom of the units page for pricing)I'm ready to orderI'm ready to order and would like a payment plan.I have questions and would like to talk to someone.I'm an existing customer and I'd like to get one Identical to the last one I ordered.Am Existing customer and I need a new camera head.I have looked at all or most of your website, I know what I want to order but I have some questions.Other

Member of NCSGCSIA CertifiedCCP Certified

Confirmation Emailexample@example.com

Format: (000) 000-0000.

We only call Cell numbers during business hours.Format: (000) 000-0000.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Street Address

Street Address Line 2

CityState

Zip CodeCountry

YesNoYes, but we've moved/under new managementNo but I bought a Chim-Scan® from Copperfield, Olympia, NECSNo, but I got a Cecure from HeatshieldNo, but I got a unit from a business I bought or from Ebay

Commercial - any chimney higher than 100ft - will require a consult with us.ResidentialBothI'm a Home Inspector

Yes, but we can shut it down for a couple of days so it can coolYes, but we have an x-amount of days it will be down for maintenance. (Please list the # of days and dates below)NoNo, it's a crematoryYes, but the fuel type is being changed, so we'll get it under 100°Other

Rows	Series 100 with Screen Shooter only (No SD)	Series 100 with SD	Series 211 with Screen Shooter Only (No SD)	Series 211 with SD
Lighthouse Tilt
J3D
Mini Enviro
Add Screen Shooter to this order even if I'm getting the SD

The rod connectors listed are the ones we can make adaptors for. IF you don't have Rods and are planning on Cleaning/Sweeping the flue, we suggest a type of locking rods like Rovac or Snaplock. IF you don't have rods and are NOT planning on Cleaning/Sweeping the Flue, we would suggest the Kwik-lock rods. If you get your rods from a big box store, you must provide a rod for us to make an adaptor. We have found great inconsistencies with those rods, region to region.

The optional Keyboard below can be added later.

Side note: adding a keyboard at a later date, requires the unit to come back since there are additional parts that have to be installed.

A standard feature on our units is the ability to use a drill battery to power the unit. We need to know the brand of drill, so we can put correct adaptor on. At this time, there isn't a universal adaptor available.

Chim-Scan Order Form

Basic Company Information

Please fill in these details the best you can. It will help us build your unit.

Thank you for giving us this information. Once our commercial chimney specialist has looked over this form, he will give you a call or email to set up a time to talk.

The Fun Part - Picking out your Unit and Camera

Please note if you are using Rod Station Rods, Hardware Store Rods, or Amazon Chimney Sweep rods. Please send us the connector from your rod, so we can put it on the camera for you. We thank you for your patience and understanding