Residential Energy Efficiency Survey

Full Name

First NameLast Name

Email Address

example@example.com

Property Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

What type of residence do you live in?

How many people live in your household?

Which of the following energy sources are used in your home? (Select all that apply)

Which appliances do you have in your home? (Select all that apply)

Have you made any recent energy efficiency upgrades? (e.g., insulation, windows, appliances)

If yes, please briefly describe the upgrades made.

Which areas would you like to improve for better energy efficiency? (Select all that apply)