Customer Name
Business Name
Business Phone Number
Format: (000) 000-0000.
Business Cell Phone Number
Format: (000) 000-0000.
Ok to Text
Yes
No
Business Email
Confirmation Email
example@example.com
Address
Unit / Suite
City
Zip Code
Preferred Language
Please Select
Cambodian
Cantonese
Chinese
English
Korean
Laotian
Mandarin
Other
Other-Asian
Other-European
Other-Middle Eastern
Persian
Punjabi
Russian
Spanish
Tagalog
Vietnamese
I, {customerName} represent that I am either the property owner or an authorized agent for the property owner. I will allow, if requested, representatives from RHA to access my property to survey the condition and document the existing equipment. I understand these surveys are for the purpose of determining available energy efficiency upgrades. I agree to this survey to be eligible to participate in the program and receive a recommendation to eligible SoCalGas program(s) and that information about my survey may be shared with other third-party programs
Yes
No
Survey Availability
Rows
AM
PM
Monday
Tuesday
Wednesday
Thursday
Friday
Reasons for Survey
High gas bills
Looking to replace equipment
Interested in Rebates and Incentives
Other
Comments
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