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Energy Assessment Intake Form

Fill out the form below and one of our dedicated customer care specialists will be in touch to schedule your assessment!

Customer Information:


Please enter this information exactly as it appears on your utility bill


Name*:

Email*:

Phone*:

Alternate Phone:

Address*:

City*:

County*:

Zip*:

Electric Account #*:

Gas Account #*:

How did you hear about us?:


Main Concerns for your home:


Do you currently have an HVAC maintenance agreement?

Have you ever had an interest in solar?:


Client care questions


Do you have any comfort issues in your home, rooms that are hotter or colder than others?*:

Do you have any drafts or drafty areas?*:

Do you have any dust issues? (If you dust Monday, can you see visibly see dust by Friday)?*:

What is your highest electric bill ($)*:

What is your highest gas bill ($)*:

Are you on levelized billing?*:

Do you have any insulation concerns/issues?*:

Do you have any issues with mold or have you had mold in your home that you know of?*:

Have you done any renovations to your home in the past year or have any currently going on (do you currently have any holes in walls, floors, or ceilings, missing trim, baseboards, crown molding, light switch or power outlet covers, or HVAC vent grilles)?*:

How many years have you lived in your home?*:

Do you own or rent your home?*:

Do you have a pool or hot tub or any other significant energy consumers? (large machinery, medical equipment, etc)*:


Home Information:

Please describe, in detail, any remodeling/construction currently taking place in your home, namely any project(s) resulting in unfinished walls, flooring, or ceilings (holes in drywall, exposed studs or ceiling/rim joists):

Is your home a single or multi-family property?*:

Are your air vents in the floor or ceiling?*:

If ceiling, how high are the highest vents in your home?:

What type of foundation does your home have (slab, crawlspace, other)?*:

Has the home been assessed before?*:

Is this a mobile home?*:

Square footage*:

Age of home (years)*:

Number of stories*:

# of HVAC Systems*:

Approx. height of ceiling*:

Specify any gas appliance*:

Do you have any unvented gas heaters/fireplaces in your home?*:

For out of town clients and/or other rural areas -- Are there any special directions needed, especially if GPS cannot locate the address?: