Electrification Questionaire and Work Request

Electrification Questionaire and Work Request

This questionaire will help us assess how to assist you best. Feel free to fill this form out even if you are not interested in immediate work.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Municipality*

CarolineCayuga HeightsDanbyDryden TownDryden VillageEnfieldFreevilleGroton TownGroton VillageIthaca CityIthaca TownLansing TownLansing VillageNewfieldTrumansburgUlysses
Type of Residence*
Square Footage (approx.)*
Year of Construction (approx.)*
Is your Heat/AC working?*

YesNo
Do you have frequent electrical outages?*

YesNo
Existing Heating Type*

Furnace (forced air/ductwork)Boiler (water baseboards)Electric baseboardHeat PumpOther
Type of Fuel*

Fuel OilPropaneNatural GasElectricWood PelletOther
Considering electric vehicle (EV) charging at this location?*

YesNo
What fossil fuel systems are in your home?*

Space HeatingOven/RangeDryerWater HeaterGas Vehicle
What investments are you considering?*

Air Source Heat Pump (ASHP)Dryer (Electric) HookupElectric Service UpgradeEV ChargerHeat Pump Water Heater (HPWH)Indoor Air Quality (IAQ)Mitsubishi CleaningMitsubishi MaintenanceStove (Electric) HookupPower Quality (surge/brown out)Repairs
What else would you like us to know?*
(Timeframe, what you are initially looking for, use of the home/building, etc.)
Should be Empty:

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