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Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you the homeowner?
*
Yes
No
Will you be adding an EV in the next 6 months?
*
Yes
No
Monthly Avg Electric Bill
*
Please Select
$50-$100
$101-150
$151-$200
$201-$250
$251-$300
$300+
Average Includes the high and low months
Which solar program do you prefer?
*
Financing
PPA/ Lease
Cash
Unsure
Please email your last month's energy bill to info@kaizenergysolutions.com
Sales Rep
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