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Free Home Energy Audit Sign-Up Form

You may complete this form online and press submit or you may print it out and fax it to (919) 872-3356. Items with a red astrisk are required fields.
Full Name*
First Name Last Name

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number*
- Area Code Phone Number
E-mail*
What are you hoping we can help you with? (Check all that apply.)*

It seems like the A/C is always running in the summer and I worry about what this is costing me. The house sometimes just feels damp and clammy in the summer. I suffer from allergies, asthma or breathing problems and I suspect my house might be making things worse. My feet are always cold in the winter because my floors are cold The room over the garage is too hot or too cold Some rooms are either too hot or too cold. I hate how dry the house feels in the winter and how the static electricity seems to get so bad. Sounds in our house seem to travel through the walls. I feel air blowing arounds windows, doors, electrical outlets and it just seems drafty. There are some areas of my house that smell damp and moldy and I have a concern about how that may affect the health of my family. I suspect that I am heating or cooling the attic or crawlspace because my ducts may be leaky. I have a dust problem. Is there anyway I can reduce the dust in my house? My spouse and I seem to disagree on what temperature to keep the house at. One of us wants to save money and the other wants to be comfortable. The attic feels like an oven in the summer. I worry about stuff that is stored up there because sometimes the heat just ruins things. It seems like I have too much air flow in some rooms and not enough in others to keep the rooms comfortable. My crawlspace is a scary place and I wonder how it is affecting the rest of the house.
Does anyone in your home suffer from any of the following medical conditions?*

Environmental Allergies (Pollen, mold, dust, pet dander etc. Respiratory Ailments Sensitivity to mold Frequent Colds Frequent Headaches None of the above
Have you had a whole house check up or energy audit in this home before? If so, who did it?*
How would you rate the importance of having a whole house check-up done on your home.Please check all that apply.*

I am curious and would just like to know if there are any problems that need attention. I have some minor concerns and want to find out if those are real Someone in my family has allergies and we want to make the house as healthy as possible. I am just interested in lowering my energy costs to ease my financial burden. I realize the impact this will have on my families health, financial well being, durability of my home and the health of the environment and want to do something now. I would like to take advantage of tax breaks and utility rebates while they are still avialable. I would like to do something in the future but not now. I am more interested in gathering information and finding out how efficient my house is.
How long have you owned your home?
How Many People Live in Your Home?
Please Tell Us a Little Bit About Your Current Energy Use.
What Types of fuel sources do you use.*

Electric Natural gas Propane Fuel oil Wood Solar
Annual Electicity Cost*
Annual Natural Gas Cost*
Annual Propane Cost
Annual Fuel Oil Cost
Annual Other Fuel Cost
What Electric Company are you with?
What Gas Company are you with?
How many thermostats does your house have?
At what temperature do you normally set your thermostat in Winter?
At what temperature do you normally set your thermostat in Summer?
Home energy audits typically take about 2-3 hours and we do ask that all homeowners be present. What is the best time to fit this into your schedule?*

Weekday Mornings Weekday afternoons Weekday evenings Weekends
Thank you very much! Enter the word below and then click submit. One of our energy auditors will be in touch shortly
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Free Home Energy Audit Sign-Up Form

Please Tell Us a Little Bit About Your Current Energy Use.

Thank you very much! Enter the word below and then click submit. One of our energy auditors will be in touch shortly