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Residential Electric Service Survey
Homeowner?
*
Yes
No
Family Owned
Rental
Not Home
Not Qualified
Who is your current electric provider?
Is your electric bill higher than usual this month?
Yes
No
Average Bill?
Highest Bill?
Lowest Bill?
Has your electric costs increased over time?
Yes
No
“I don’t know”
“I just moved in”
If an option exists to get electricity for less than what you are paying now, would you be open to more information?
Yes
No
Do you get your electric bill online or paper copy in the mail?
Online
Mail
“My spouse handles it”
“It’s on auto pay”
Picture of Electric Bill
Upload Electric Bill
Browse Files
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of
Homeowner(s)
First Name
Last Name
Property Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Appointment
Notes
Surveyor
*
First Name
Last Name
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