Fireplace Measurements Form

Customer Name

First Last

Email

Salesperson/Tech

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Work Phone

Home Phone

Cell Phone

Date

A. Width-Front

B. Width-Rear

C. Height-Center

D. Height-Side

E. Firebox Depth

F. Hearth Measurement

G. Distance to Side Mantle Left (or combustible surface)

H. Height to Mantle (or combustible surface)

J. Distance to Side Mantle Right (or combustible surface)

K. Width of Lintel

Is this an arch fireplace?

Is this a prefabricated or all metal fireplace?

Is this an all masonry fireplace?

Is there a drop between the hearth and the firebox?

How much?

Please note any unusual protruding bricks.

Is there anything unusual about the fireplace?

Type of Facing:

Is a flue liner in chimney?

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