Centerpoint Energy Customer Experience Collaborative Application

CenterPoint Energy

Customer Experience Collaborative Application Questionnaire
Are you a CenterPoint Energy Customer?*

YesNo

Thank you for your interest. This program is only for CenterPoint Energy Customers.

Are you a residential or business customer?*

ResidentialBusiness

What type of residence do you live in?*

Single-family homeMulti-family home (e.g. duplex,triplex)ApartmentCondominiumOther

Do you own or rent your home?*

OwnRent

How many people live in your household?*

What is your primary heating source?*

GasElectricOther

Which services do you have through CenterPoint Energy?*

GasElectricCombination (Gas and Electric)

Do you have solar or another source of renewable energy in your home?*

YesNo

Please describe*

Are you interested in energy technology and trends?*

YesNo

Please describe*

Why do you want to participate in the Customer Experience Collaborative?*

How did you learn about the Customer Experience Collaborative?*

CenterPoint Energy WebsiteSocial MediaBill InsertNewspaper, TV, RadioEmailOther

How would you rate your current satisfaction with CenterPoint Energy? Note: Answering this question is voluntary and will not affect your application.

Very satisfiedSatisfiedNeutralDissatisfiedVery dissatisfied

Are you related to or have a close connection with a CenterPoint Energy Employee?*

YesNo

Please describe*

Are you currently holding a public office?*

YesNo

Have you previously participated in a customer advisory group?*

YesNo

Please describe*

What is your age range?*

18-2425-3535-4445-5455-6465 and over

Which of the following best describes you? Please select one.*

Asian or Pacific IslanderBlack or African AmericanHispanic or LatinoNative American or Alaska NativeWhite or CaucasianMultiracial or BiracialA race/ethnicity not listed here

What is your annual household income range?*

Less than $20,000$20,000 to $34,999$35,000 to $49,999$50,000 to $74,999$75,000 to $99,999$100,000 to $149,999$150,000 and above

Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.

How many employees do you have?*

Do you have remote workers?*

YesNo

How many?*

Where are your business operations located?*

Do you own or rent your facilities?*

OwnRent

How many buildings do you own or rent?*

What is the estimated square footage of your building(s)?*

What is your primary energy source?*

GasElectricOther

Do you have solar or other source of renewable energy in your business?*

YesNo

Please describe*

How would you rate your current satisfaction with CenterPoint Energy? Note: Answering this question is voluntary and will not affect your application.

Very satisfiedSatisfiedNeutralDissatisfiedVery dissatisfied

Do you have a CenterPoint Energy Key Account Manager?*

YesNo

Are you currently holding public office?*

YesNo

Are you a decision maker at your facility?*

YesNo

Why do you want to participate in the Customer Experience Collaborative?*

How did you learn about the Customer Experience Collaborative?*

CenterPoint Energy WebsiteSocial MediaBill InsertNewspaper, TV, RadioEmailOther

Are you interested in new energy effeciency technology and trends?*

YesNo

Please describe*

Have you participated in energy efficiency programs in the past?*

YesNo

Please describe*

Have you previously participated in a customer advisory group?*

YesNo

Please describe*

Are you related to or have a close connection with a CenterPoint Energy employee?*

YesNo

Please describe*

Name*

First NameLast Name
Title*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.

Thank you for your interest in the Customer Experience Collaborative!

A representative may contact you in the next 2-3 weeks with follow up questions and/or to notify you of your selection to participate as a Collaborative member.
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