No-Visit Energy Assessment

Name*

Email*

Phone*

Address 1*

Address 2

How large is your home?*- Select a value -less than 1000 sq ftbetween 1001 and 2000 sq ftbetween 2001 and 3000 sq ftbetween 3001 and 4000 sq ftbetween 4001 and 5000 sq ftgreater than 5000 sq ft

General square footage of your home*

How many stories?*- Select a value -123456+

My house was built...- None -Before 18501850 - 18801881 - 19001901 - 19401941 - 19601961 - 1980After 1980

Number and Size of bedrooms (Please provide the approx. square footage for each bedroom)

I heat my home with...*- Select a value -GasElectric

Do you have Air Conditioning (AC)?*- Select a value -YesNo

Does your home have any noticeably uncomfortable rooms?

What type of water heater do you have?*- Select a value -Tank - GasTank - ElectricOn Demand (any kind)

What kind of foundation do you have?*- Select a value -Concrete SlabPoured Concrete Foundation (Full Basement)Poured Concrete Foundation (Crawl Space)Other - explain below

How long does it take to get hot water at your furthest faucet?

What condition are your windows in?- None -They're original to the houseI (or a previous owner) upgraded themThey need to be replacedDouble Pane windowsSingle Pane windowsPartially New windowsI'm not sure

Comments

How well insulated are your walls?*- Select a value -They aren't insulatedNot very insulatedSomewhat insulatedWell insulatedPerfectly insulatedI don't know

Are your floors insulated?*- Select a value -YesNoI'm not sure

Is your attic insulated?*- Select a value -Not insulatedSomewhat insulatedWell insulatedPerfectly insulatedI don't have an attic

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