Home Energy Survey

Home Energy Survey: for EcologicalNJ LLC
Full Name

First NameLast Name
Phone Number

Area CodePhone Number
E-mail
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Have you ever had a whole house energy audit done by a professional?
If yes, how long ago?
When was your home built?
What type of heating system do you use in your home? (check all that apply)
How old is your furnace?
What type of water heater do you have?
How old is your water heater?
What type of Air Conditioner do you have? (check all that apply)
Have you upgraded any of the following appliances in the last 5 years (check all that apply)
How many incandescent light bulbs have you changed to compact fluorescents?
Describe your windows:
How would you describe air leakage/drafts around your house?
Have you added any insulation to the (check all that apply)
Are you considering remodeling your home in the next...
Do you use a programmable thermostat?
At what temperature is the thermostat set during (enter your answers)
Winter Daytime
Winter Nighttime:
Summer Daytime:
Summer Nighttime:
Would you be interested in a free quote for solar electricity on your own home?
Would you be interested in a professional whole house energy assessment on your own home?
Check as many boxes below that apply to you:
Are you planning to sell your home in the next...
Home Ownership
Should be Empty:

Home Energy Survey: for EcologicalNJ LLC