Customer Name
*
Business Name
Business Phone Number
Business Cell Phone Number
Ok to Text
Yes
No
Business Email
Confirmation Email
example@example.com
Business Address
Street Address
Unit/Suite
City
State / Province
Postal / 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
AM
PM
Monday
Tuesday
Wednesday
Thursday
Friday
Reasons for Survey
High gas bills
Looking to replace equipment
Interested in Rebates and Incentives
Other
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