Does Your Home Need an Home Energy Evaluation?
  Fill out the form below and we will contact
you soon for a free in-home evaluation.
   
  *Required
Name*:
Street:
City:
State:
Zip:
Daytime Phone*:
Evening Phone:
E-mail*:

1. What year was your home built?
2. What is the square footage of your home?
3. Number of people in home?
4. Own or rent:
Own Rent
5. Thermostat is set at:
Summer     Winter
6. Thermostat is:
Manual Programmable
7. Condition of your ducts are:
Poor
Average
Good
Unknown
8. Wall Insulated:
Yes No
9. Floors Insulated:
Yes No
10. Attic Insulated:
Yes No
11. Home fuel type:
Oil
Wood
Natural Gas
Electric
Propane
12. Type of home:
Detached single-family
Townhouse/Condominium
Apartment
Duplex
Manufactured/Mobile Home
Other
13. Construction type?
Wood Frame
Block
Log
Other
14. Foundation:
Slab
Enclosed crawl space
Open crawl space
Basement
15. Type of windows:
Single pane
Double pane
Triple pane
16. Do you have storm windows?
Yes No
17. Type of exterior doors in your home:
Hollow wood
Solid wood
Insulated metal
Fiberglass
18. Do you have a storm door?
Yes No
19. What brand of furnace do you currently have?
20. How old is your furnace?
years
21. What was the efficiency of your furnace when it was new
% AFUE
22. Do you have an air conditioner or heat pump?
A/C Heat Pump
23. What was the efficiency of your AC/HP when it was new
SEER
24. Number of fireplaces:
Wood     Gas

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