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DUE DILIGENCE INTAKE FORM
DIRECTLY AFTER COMPLETION, YOU WILL BE REDIRECTED TO SCHEDULE
Get your home audit
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1
Your Name
*
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(Please include utility account if different)
First Name
Last Name
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2
Home Address
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Street Address
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City
State / Province
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Sudan
Suriname
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eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
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Ukraine
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Vatican City
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Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
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Other
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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3
Preferred Email
*
Required
We will use this for coordination purposes only
example@example.com
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4
Phone Number
*
Required
What is the best number to reach you
Please enter a valid phone number.
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5
Is Texting On Your Phone Ok?
*
Required
We understand
how busy life can be
YES
NO
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6
My main reason for requesting an energy audit is
*
Required
Please Describe
Reduction of Usage-High bills
For Improved Home Comfort
To improve Indoor Air Quality
Please Describe
Please Describe
Reduction of Usage-High bills
For Improved Home Comfort
To improve Indoor Air Quality
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7
Select Areas
That Cause
Winter Discomfort
In Your Home?
*
Required
Select areas that are
uncomfortable and drafty
Doors
Windows
Basement
Crawlspace
First Floor Of Home
Whole Home
🚫 NONE
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8
Your Heat Type
*
Required
Choose
Primary
Source Used
Electricity
Utility Gas
Propane
Oil
Wood or Pellet
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9
How Is Your Home Heated
?
*
Required
Choose Style
Electric Heat Pump (Heating And Cooling)
Electric Baseboard Heating
Non Electric Forced Air
Boiler With Radiators / Baseboards
Mini-Splits
Other
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10
Select Areas
That Cause
Summer Discomfort
In Your Home?
*
Required
Select areas that are
uncomfortable or humid
2nd Floor
Loft
3rd Floor
Whole Home
🚫 NONE
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11
Do You Have Central Air Conditioning?
*
Required
You Have Both Indoor And Outdoor Units
Electric Heat Pump
Central AC only
Mini-Splits
No Central Air Conditioning
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12
Where is your Air Handler Unit Located (forced air systems)
*
Required
This Moves And Filters Your Air
Crawlspace (below)
Basement
Attic
Non-App;icable
Please Select
Crawlspace (below)
Basement
Attic
Non-App;icable
Select If Applicable
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13
What is your account number
*
Required
*
Must Complete
For PPL Electric
Rebate Qualification
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14
Do You Heat Your Home With Gas
*
Required
UGI
GAS
YES
NO
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15
What is your account number
*
Required
*
Must Complete
For UGI Gas
Rebate Qualification
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16
Why do you think your home is uncomfortable or your usage is high?
*
Required
Your best guess
I may need attic air sealing or insulation
I could have duct leakage, there are rooms furthest from system that have little/no flow
I have drafts coming in around doors and windows
I have cold floors and may need basement or crawl space wall insulation
I have no idea and need a pro
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17
Discovery Call Appointment
Would you like a link sent to you with scheduling options eg. dates,, time slots for this phone call
YES
NO
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18
Where Is Your Attic Hatch(s) Located?
*
Required
Please
choose all type
(s),
please have access
clear for us to inspect the zone(s)
My attic hatch is small and in a closet
My attic hatch is in a hallway
Stairs pull down to access my attic
Small doors lead to crawl space or cubby holes
I have a walk up attic with built stairs
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19
The On-Site Scheduling Details
*
Required
Please List Flexibility/Availability Eg:
Days Preferred, Am or Pm
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20
Electric Utility Usage
Please upload 6-12 months of your utility usage for us to begin to understand how your home performs. This is especially useful during our "boots on the ground" on-site visit and testing.
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
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of
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21
Gas (or other) Utility Usage (bills)
Please upload 6-12 months of your utility usage (bills) for us to begin to understand how your home performs. This is especially useful during our "boots on the ground" on-site visit and testing.
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
Browse Files
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of
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22
Request Date
Next Best Day
-
Date
Year
Month
Day
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