Wisconsin Nomination Form

Nominations close 8/31

Please provide the following information regarding the person or family you are nominating.

Person Making The Nomination

Your Name*

Your City*

Your State*

Your Zip code*

Your Telephone*

Your Email Address*

Relationship to nominee

Individual or Family Being Nominated

Their Name*

Their Address*

Their City*

Their State*

Their Zip code*

Their Telephone*

Their Email (if known)

How would you best classify the nominee? Considered to be a community leader Has fallen on hard times or challenges Unsung heroes who put serving others first - whether its with their time or resources Veterans Seniors living in homes with older systems People impacted by natural disasters Other

Tell us their story, including why this nominee deserves to be chosen as a Feel The Love recipient and the impact that receiving a new furnace or A/C unit this year would have.

List details about current heating / cooling system details if possible

Is this home in need of a replacement furnace and/or major service to the existing furnace? UnknownYesNo

Does nominee/family own this home? UnknownYesNo

Is the home a mobile home/manufactured housing? UnknownYesNo

Does the home have a furnace with complete ductwork system in place, i.e. a central forced air system? (Select no if the home has a boiler or hydronic system, uses a wood stove, electric baseboards, or other heating method) UnknownYesNo

How Did You Hear About Us (check all that apply)

Newspaper Ad

Social Media

Radio Ad by Local Lennox Dealer

Lennox Dealer Leave-Behind Info

Local Flyer / Poster

Outdoor Billboard

Lennox Dealer Statement / Invoice

Friend or Neighbor Information

Truck Advertising

Veterans Information

Prior Recipient

Prior Nominator

Direct Mail

Other (please specify in box below)

If from a Lennox Dealer, please enter the Dealer name here:

If from a Lennox Dealer, please enter the Dealer number here:

* I have reviewed and agree to program terms and conditions.