Please enter your name and contact information:
Name: State:
Address: Zip:
City: Work Phone:
E-mail: Evening Phone:

Main source of cooling?

Main source of heating?

Year home was built:

Own or rent home:
Rent
Own

What year did you move into your home?

How many people live at home?

Type of home?
Single-family detached
Townhouse/Condominium
Apartment/Duplex
Mobile/Manufactured Home
Other

Home's construction type?
Wood Frame
Steel Frame
Other

Square footage of your home(cooled/heated):
Less than 1,000 sq. ft.
1,000-1,499 sq. ft.
1,500-1,999 sq. ft.
2,000-2,499 sq. ft.
2,500-2,999 sq. ft.
3,000-3,499 sq. ft.
3,500-3,999 sq. ft.
4,000-4,499 sq. ft.
4,500-4,999 sq. ft.
5,000 sq. ft. or more


Home's foundation:
Slab on grade
Enclosed crawl space
Open crawl space
Full basement

Type of Thermostat?
Manual
Programmable

What temperature do you set your thermostat?
Summer
Winter

Insulated:

Wall

Yes
No


Floors

Yes
No


Attic

Yes
No

Type of windows in your home:
Single pane
Double pane
Triple pane


Type of exterior doors in your home:
Hollow wooden
Solid wooden
Insulated metal

Do you have a storm door?
Yes
No

What is the condition of your ducts?
Poor
Average
Good
Unknown

Home fuel type:
Wood
Electric
Natural gas
Fuel oil
Propane


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